Provider Demographics
NPI:1760498695
Name:MAXWELL JR, DONALD P (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:MAXWELL JR
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 1:12318 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8604
Mailing Address - Country:US
Mailing Address - Phone:405-752-0717
Mailing Address - Fax:405-752-0711
Practice Address - Street 1:12318 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8604
Practice Address - Country:US
Practice Address - Phone:405-752-0717
Practice Address - Fax:405-752-0711
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21520207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100106780AMedicaid
OKB63010Medicare UPIN
OKP00644737Medicare PIN
OK100106780AMedicaid