# RALPH MARTIN MAXWELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1295722668
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 00356 | ID | Yes |

## Other

- **Enumeration date:** 09/30/2005
- **Last updated:** 12/20/2011

## 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 |