Individual
RALPH MARTIN MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
811 HIGHWAY 65 S, DUMAS, AR 71639-3006
(870) 382-8261
(870) 382-8140
Mailing address
811 HIGHWAY 65 S, PO BOX 830, DUMAS, AR 71639-3006
(870) 382-8261
(870) 382-8140
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00356
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149459
REGENCE BS OF ID
ID
01
—
0194584
DEPT OF LABOR & INDUSTRY
WA
05
—
807073500
—
ID
05
—
8434870
—
WA
01
—
P00192008
RAILROAD MEDICARE
—
01
—
S5494
BLUE CROSS OF ID
ID
Enumeration date
09/30/2005
Last updated
12/20/2011
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