Provider Demographics
NPI:1467504506
Name:MAXSON, JAMI A (MD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:A
Last Name:MAXSON
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 1:2815 EDGEWOOD ROAD S.W.
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404
Mailing Address - Country:US
Mailing Address - Phone:319-221-8695
Mailing Address - Fax:319-369-9916
Practice Address - Street 1:2815 EDGEWOOD ROAD S.W.
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404
Practice Address - Country:US
Practice Address - Phone:319-221-8695
Practice Address - Fax:319-369-9916
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6103234Medicaid
IA18765OtherWELLMARK
IAF99116Medicare UPIN
IAI12331Medicare ID - Type Unspecified