Provider Demographics
NPI:1083634208
Name:MAXWELL, REBECCA HELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:HELENA
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 MIRAGLEN DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9055
Mailing Address - Country:US
Mailing Address - Phone:713-598-6265
Mailing Address - Fax:281-485-9089
Practice Address - Street 1:3518 BRANDEMERE DR
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9446
Practice Address - Country:US
Practice Address - Phone:713-598-6265
Practice Address - Fax:281-485-9089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL65192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G7085OtherBLUE CROSS BLUE SHIELD
TX100228194OtherAMERIGROUP
TX182265201Medicaid
TX182265201Medicaid
TX8G6787Medicare PIN