Individual
MRS. MARY MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1175 58TH AVE, STE 202, GREELEY, CO 80634-4807
(970) 495-0300
(970) 224-9624
Mailing address
1175 58TH AVE, STE 202, GREELEY, CO 80634-4807
(970) 495-0300
(970) 224-9624
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
26903
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01269034
—
CO
01
—
121925100
WYOMING MEDICAID
WY
01
—
313017
BLUE SHIELD
WY
01
—
P00396253
RAILROAD MEDICARE
—
Enumeration date
09/20/2005
Last updated
02/27/2008
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