Provider Demographics
NPI:1659376812
Name:MAXWELL, ALAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 21231
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402-1231
Mailing Address - Country:US
Mailing Address - Phone:205-366-3010
Mailing Address - Fax:205-366-3012
Practice Address - Street 1:115 HARPER COURT
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1250
Practice Address - Country:US
Practice Address - Phone:205-366-3010
Practice Address - Fax:205-366-3012
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL8133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL8133OtherLICENSE
C72560Medicare UPIN