Provider Demographics
NPI:1063507739
Name:MAXWELL, KEITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27877
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0877
Mailing Address - Country:US
Mailing Address - Phone:828-694-8385
Mailing Address - Fax:828-694-7654
Practice Address - Street 1:21 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-274-4555
Practice Address - Fax:828-274-3615
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27823207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200038382OtherMEDICARE RR PROVIDER NUMB
NCP00916635OtherRR MEDICARE
NCA3023OtherMEDCOST PROVIDER NUMBER
NC1114GOtherBCBS OF NC PROVIDER NUMBE
NC891114GMedicaid
NC1114GOtherBCBS OF NC PROVIDER NUMBE
NCC82277Medicare UPIN