Individual
JOHN KEVIN MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 NW 12TH AVE # 1611, MIAMI, FL 33136-1005
(406) 939-0391
Mailing address
PO BOX 114, FALLON, MT 59326-0114
(406) 939-0391
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
ME168491
FL
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
ME168491
FL
2085N0700X
Neuroradiology Physician
ME168491
FL
2085P0229X
Pediatric Radiology Physician
ME168491
FL
2085R0202X
Diagnostic Radiology Physician
Primary
ME168491
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME168491
FL
2085U0001X
Diagnostic Ultrasound Physician
ME168491
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12076
—
ND
01
—
22500
BLUE SHIELD
ND
05
—
59823
—
MT
01
—
A001 A002
TRICARE WPS
ND
Enumeration date
12/06/2006
Last updated
06/14/2024
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