Individual
DR. JACKIE D MAXEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 PROFESSIONAL DR, SUITE #2, LONDON, KY 40741-8857
(606) 878-9611
(606) 862-7565
Mailing address
PO BOX 1676, LONDON, KY 40743-1676
(606) 878-9611
(606) 862-7565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35548
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64009913
—
KY
Enumeration date
08/12/2006
Last updated
08/15/2014
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