Provider Demographics
NPI:1316576127
Name:MAXWELL, CHRISTIAN TRAVIS WADE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:TRAVIS WADE
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:FAIR OAKS PAVILION RM 247
Mailing Address - Street 2:5440 LINTON BOULEVARD
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-381-7048
Mailing Address - Fax:
Practice Address - Street 1:FAIR OAKS PAVILION RM 247
Practice Address - Street 2:5440 LINTON BOULEVARD
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-381-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program