Individual
JOHN E MAXWELL II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
109 CIRCLE DR, WEST MONROE, LA 71291-5303
(318) 323-1834
(318) 323-0376
Mailing address
PO BOX 731280, DALLAS, TX 75373-1280
(318) 841-9526
(318) 841-9551
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
020373
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10984058
CAQH ID#
LA
05
—
1534901
—
LA
01
—
P01310356
RR MEDICARE
LA
Enumeration date
08/03/2005
Last updated
07/22/2016
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