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Individual
RALPH MARTIN MAXWELL
Active
Individual
RALPH MARTIN MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00356
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149459
REGENCE BS OF ID
ID
01
—
0194584
DEPT OF LABOR & INDUSTRY
WA
05
—
807073500
—
ID
05
—
8434870
—
WA
01
—
P00192008
RAILROAD MEDICARE
—
01
—
S5494
BLUE CROSS OF ID
ID
Enumeration date
09/30/2005
Last updated
12/20/2011
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