Provider Demographics
NPI:1235468331
Name:MAXWELL, JESSIE RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:RUTH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-277-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:PEDIATRICS NEONATOLOGY MSC10 5590
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2023-09-22
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2015-06152080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program