Provider Demographics
NPI:1851598247
Name:MAXWELL, GWENDOLYN SUE (MD , FACS)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:SUE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:MD , FACS
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:SUE
Other - Last Name:MAXWELL - DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD , FACS
Mailing Address - Street 1:2490 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6522
Mailing Address - Country:US
Mailing Address - Phone:520-751-1225
Mailing Address - Fax:520-751-2008
Practice Address - Street 1:2490 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6522
Practice Address - Country:US
Practice Address - Phone:520-751-1225
Practice Address - Fax:520-751-2008
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21869208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery