Provider Demographics
NPI:1508841560
Name:MAXWELL, DONALD K (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:K
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4707
Mailing Address - Country:US
Mailing Address - Phone:480-412-6042
Mailing Address - Fax:480-412-5235
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-412-6042
Practice Address - Fax:480-412-5235
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3821207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ736788Medicaid
H57220Medicare UPIN
AZ736788Medicaid
AZZ115225Medicare PIN