Individual
KIRK PATRICK MAXINO UY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 NE 87TH AVE STE 260, VANCOUVER, WA 98664-4896
(360) 882-2778
(360) 604-1693
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664-4896
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60458547
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2036043
—
WA
05
—
500671834
—
OR
Enumeration date
05/24/2012
Last updated
07/24/2020
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