Provider Demographics
NPI:1619186459
Name:MAXWELL, SETH C (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:C
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 1:27407 N 58TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1266
Mailing Address - Country:US
Mailing Address - Phone:602-663-3830
Mailing Address - Fax:
Practice Address - Street 1:27407 N 58TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1266
Practice Address - Country:US
Practice Address - Phone:602-663-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36235174400000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ126180Medicare UPIN
AZZ126179Medicare UPIN
AZZ120952Medicare PIN
AZZ126048Medicare PIN