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1508825456
SHANE A MAXWELL
MERIDIAN, ID
NPI
1508825456
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
208VP0014X Pain Medicine, Interventional Pain Medicine
(Licence: ID O0385)
Enumeration Date
2006-03-20
Last Update Date
2022-07-21
Business Address
Mr. SHANE A MAXWELL D.O.
3551 E OVERLAND RD
MERIDIAN, ID 83642-6757
Phone number: 208-884-1333
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Mailing Address
Mr. SHANE A MAXWELL D.O.
PO BOX 1128
BOISE, ID 83701-1128
Phone number: 208-381-2222
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