Provider Demographics
NPI:1760594378
Name:MAXEY, BRADFORD WAYNE (PA)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:WAYNE
Last Name:MAXEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 WEST PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-250-5700
Mailing Address - Fax:
Practice Address - Street 1:1023 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4042
Practice Address - Country:US
Practice Address - Phone:580-436-4400
Practice Address - Fax:580-436-4406
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00170363A00000X
OK709363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87N208OtherBCBS
TX970012800OtherRAILROAD
TX87N208OtherBCBS