Individual
PHILLIP MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A
Contact information
Practice address
1707 N MILLS AVE, ORLANDO, FL 32803-1851
(407) 647-3960
(407) 413-5775
Mailing address
1707 N MILLS AVE, ORLANDO, FL 32803-1851
(407) 647-3960
(407) 413-5775
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9109570
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114953900
—
FL
Enumeration date
09/05/2013
Last updated
05/08/2024
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