Provider Demographics
NPI:1659396323
Name:MAXWELL, KEVIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10831 COMBIE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8953
Mailing Address - Country:US
Mailing Address - Phone:530-728-3500
Mailing Address - Fax:530-728-3501
Practice Address - Street 1:10831 COMBIE RD
Practice Address - Street 2:SUITE D
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8953
Practice Address - Country:US
Practice Address - Phone:530-728-3500
Practice Address - Fax:530-728-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G513210Medicaid
207Q00000XOtherTAXONOMY PITS
CAA51968Medicare UPIN
CA00G513210Medicaid