Provider Demographics
NPI:1336226661
Name:DONALD P MAXWELL JR MD PLLC
Entity Type:Organization
Organization Name:DONALD P MAXWELL JR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-752-0717
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21520207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty