Individual
EDWARD MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4800 FREDERICKSBURG RD, SUITE 127, SAN ANTONIO, TX 78229-3628
(210) 733-5072
(210) 733-8649
Mailing address
PO BOX 1239, TROY, MI 48099-1239
(248) 824-6600
(248) 324-1477
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01907
TX
363AM0700X
Medical Physician Assistant
PA01907
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191882301
—
TX
Enumeration date
08/12/2006
Last updated
05/20/2013
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