Organization
MARK S MAXWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA MAXWELL (OFFICE MANAGER)
(325) 674-9494
Entity
Organization
Contact information
Practice address
1525 HICKORY STREET, ABILENE, TX 79601-2906
(325) 674-9494
(325) 674-9493
Mailing address
1525 HICKORY STREET, ABILENE, TX 79601-2906
(325) 674-9494
(325) 674-9493
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
J9754
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13NL
BCBS
TX
Enumeration date
05/08/2006
Last updated
12/06/2007
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