Individual
DR. MICHAEL GORDON MAXWELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4201 BELFORT RD, JACKSONVILLE, FL 32216-1431
(904) 296-3700
Mailing address
4500 SAN PABLO RD S, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME34417
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15572
BLUECROSS/BLUESHIELD
FL
Enumeration date
10/04/2005
Last updated
07/08/2007
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