Individual
JUSTIN EVAN MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4730 S FORT APACHE RD STE 150, LAS VEGAS, NV 89147-7959
(702) 940-1570
(702) 940-1571
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO1829
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386938777
—
NV
01
—
DO1829
STATE LICENSE
NV
Enumeration date
06/03/2011
Last updated
10/19/2022
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