Individual
KYLE MAXUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0008848
CO
363A00000X
Physician Assistant
—
—
Other
Enumeration date
12/08/2023
Last updated
11/12/2024
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