Provider Demographics
NPI:1669464194
Name:MAXEY, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:MAXEY
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 1:1600 LANCASTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3579
Mailing Address - Country:US
Mailing Address - Phone:972-406-3000
Mailing Address - Fax:972-406-3005
Practice Address - Street 1:1600 LANCASTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3579
Practice Address - Country:US
Practice Address - Phone:972-406-3000
Practice Address - Fax:972-406-3005
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1603207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105336503Medicaid
TXF37151Medicare UPIN
TX8L1156Medicare PIN