Individual
DR. JOHN A MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 MEDICAL DRIVE, LAKE JACKSON, TX 77566-5674
(979) 285-1937
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J2189
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116444404
—
TX
01
—
P00675466
RR MEDICARE
TX
Enumeration date
02/27/2006
Last updated
03/19/2015
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