Maxey, Jackie D
Maxey, Jackie D is an sole proprietor health care provider with primary practice located at 102 Professional Dr Suite #2, London KY 40741-8857. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Maxey, Jackie D can be contacted via phone (606) 878-9611.Contact Information
Primary practice address
102 Professional Dr Suite #2
London KY 40741-8857
Phone: (606) 878-9611
Fax: (606) 862-7565
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 35548 | Kentucky |
Profile Details
| NPI number | 1073525861 |
|---|---|
| LBN Legal business name | Maxey, Jackie D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 12th, 2006 |
| Last updated | Aug 15th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073525861 | NPPES |
| Kentucky | MEDICAID | 64009913 |
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