Provider Demographics
NPI:1073615241
Name:MAXWELL, RICHARD G (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:3741 W 12600 S
Practice Address - Street 2:RIVERTON HOSPITAL
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-285-4000
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT380672-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118872100Medicaid
AZ820169Medicaid
UT870545614MA4OtherEDUCATORS MUTUAL
UTTPRA07189OtherMOLINA
UT1070146632101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT75172OtherPEHP
ID806442900Medicaid
UT8221004OtherDESERET MUTUAL
NV100501251Medicaid
UTQM0000075886OtherALTIUS
UT38067212001001OtherBCBS
UTP00075960Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT38067212001001OtherBCBS
UT75172OtherPEHP