Individual
MAXFIELD ROY LAWRENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1118 NW 16TH ST STE D, FRUITLAND, ID 83619-2272
(208) 452-7677
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8748
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2104
ID
Other
Enumeration date
09/09/2021
Last updated
01/09/2025
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