Provider Demographics
NPI:1891789384
Name:MAXCY, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:MAXCY
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 1:6780 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE A101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5049
Mailing Address - Country:US
Mailing Address - Phone:602-843-1991
Mailing Address - Fax:602-843-1991
Practice Address - Street 1:6780 W THUNDERBIRD RD
Practice Address - Street 2:SUITE A101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5049
Practice Address - Country:US
Practice Address - Phone:602-843-1991
Practice Address - Fax:602-843-1991
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ208448Medicaid
AZ208448Medicaid