Provider Demographics
NPI:1205898681
Name:MAXWELL, WILLIAM ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:MAXWELL
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 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5010
Mailing Address - Fax:559-449-5014
Practice Address - Street 1:1360 E HERNDON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5010
Practice Address - Fax:559-449-5014
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35175207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1304310001OtherCIGNA MEDICARE DMERC
CAGR0078920Medicaid
CAGR0078924Medicaid
CA1304310005OtherCIGNA MEDICARE DMERC
CAGR0078921Medicaid
CA00G351750Medicaid
CAGR0078923Medicaid
CA1304310002OtherCIGNA MEDICARE DMERC
CA1304310003OtherCIGNA MEDICARE DMERC
CA1304310004OtherCIGNA MEDICARE DMERC
CAGR0078922Medicaid
CA1304310001OtherCIGNA MEDICARE DMERC
CAZZZ13882ZMedicare PIN
CAA46242Medicare UPIN
CA00G351750Medicaid
CAGR0078924Medicaid
CA00G351752Medicare PIN
CA00G351753Medicare PIN
CAZZZ13883ZMedicare PIN
CAGR0078923Medicaid
CAGR0078920Medicaid
CAZZZ13845ZMedicare PIN
CA00G351751Medicare PIN