Provider Demographics
NPI:1053306415
Name:AXTELL, HOWARD M (DO)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:M
Last Name:AXTELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MCCLINTIC DR
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2130
Mailing Address - Country:US
Mailing Address - Phone:254-729-3411
Mailing Address - Fax:254-729-3258
Practice Address - Street 1:801 MCCLINTIC DR
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-2130
Practice Address - Country:US
Practice Address - Phone:254-729-3411
Practice Address - Fax:254-729-3258
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014539129OtherRAILROAD MEDICARE
TX00KR03OtherBCBS
TX111481101Medicaid
D97176Medicare UPIN
TX111481101Medicaid