Provider Demographics
NPI:1962403550
Name:MAXWELL, PATRICIA A (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-6104
Mailing Address - Country:US
Mailing Address - Phone:979-245-5600
Mailing Address - Fax:979-245-5614
Practice Address - Street 1:2417 AVENUE I
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-6104
Practice Address - Country:US
Practice Address - Phone:979-245-5600
Practice Address - Fax:979-245-5614
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
610656Medicare ID - Type Unspecified
E77863Medicare UPIN