Provider Demographics
NPI:1033132071
Name:JOHN A. MAXEY MD, PA
Entity Type:Organization
Organization Name:JOHN A. MAXEY MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-406-3000
Mailing Address - Street 1:701 TUSCAN STE 205
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3838
Mailing Address - Country:US
Mailing Address - Phone:972-406-3000
Mailing Address - Fax:972-406-3005
Practice Address - Street 1:701 TUSCAN STE 205
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3838
Practice Address - Country:US
Practice Address - Phone:972-406-3000
Practice Address - Fax:972-406-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1603207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105336503Medicaid
TX105336503Medicaid