Provider Demographics
NPI:1124548805
Name:MAXWELL, JOSHUA BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BRENT
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8822 S REDWOOD RD STE C211
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9340
Mailing Address - Country:US
Mailing Address - Phone:801-563-1975
Mailing Address - Fax:
Practice Address - Street 1:8822 S REDWOOD RD STE C211
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9340
Practice Address - Country:US
Practice Address - Phone:801-563-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1153855338905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics