Provider Demographics
NPI:1275251803
Name:TJAUW, MAXMILLIAN JOSEPH
Entity Type:Individual
Prefix:
First Name:MAXMILLIAN
Middle Name:JOSEPH
Last Name:TJAUW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18924 SADDLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4102
Mailing Address - Country:US
Mailing Address - Phone:503-720-0493
Mailing Address - Fax:
Practice Address - Street 1:800 STANTON L YOUNG BLVD # 405
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5018
Practice Address - Country:US
Practice Address - Phone:405-271-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program