Individual
LUKE MAXFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
607 BEAMAN ST, CLINTON, NC 28328-2603
(910) 596-5421
(412) 712-8567
Mailing address
10298 WALDEN ST, SODDY DAISY, TN 37379-5152
(412) 712-8567
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2020-03771
NC
207N00000X
Dermatology Physician
Primary
4372
TN
207ND0101X
MOHS-Micrographic Surgery Physician
2020-03771
NC
207ND0101X
MOHS-Micrographic Surgery Physician
4372
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020-03771
STATE LICENSE
NC
01
—
4372
STATE LICENSE
TN
Enumeration date
03/16/2016
Last updated
07/15/2024
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