Provider Demographics
NPI:1629163167
Name:MAXWELL, ELVIN EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ELVIN
Middle Name:EDWARD
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 1739
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-0005
Mailing Address - Country:US
Mailing Address - Phone:210-286-6577
Mailing Address - Fax:
Practice Address - Street 1:300 VETERAN'S BLVD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical