Gwendolyn Sue Maxwell, M.D. , F.A.C.S.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

21869 Issued in AZ

Practice address

2490 E River Rd
Tucson, AZ 85718-6522

Phone

(520) 751-1225

Fax

(520) 751-2008

NPI assigned

Jun 28, 2007

Last updated

Apr 25, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Gwendolyn Sue Maxwell - Davis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 2, 2015 through Apr 2, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maxwell Aesthetics PC

  • Specialist
  • Tucson, AZ
  • NPI 1063734200
  Authorized official Same address or phone
• Tucson Plastic Surgery

  dba Chaotiq Endeavors

  • Plastic and Reconstructive Surgery Physician
  • Tucson, AZ
  • NPI 1700475977

  Plastic Surgery

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398384000000",
    "number": "1851598247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 E RIVER RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857186522",
            "telephone_number": "520-751-1225",
            "fax_number": "520-751-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 E RIVER RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857186522",
            "telephone_number": "520-751-1225",
            "fax_number": "520-751-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "GWENDOLYN",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "M.D. , F.A.C.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2014-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "AZ",
            "license": "21869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GWENDOLYN",
            "last_name": "MAXWELL - DAVIS",
            "middle_name": "SUE",
            "prefix": "MRS.",
            "credential": "M.D. , F.A.C.S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael J. Maximov, M.D.
• Maximum Impact Physical Therapy Services, LLC
• Maureen Maxon, PH.D.
• Maxwell Aesthetics PC
• Annie Maxwell, RN
• Kate Marie Maxwell
• Mark E Maxwell, MD
• Reynelda Felder Maxwell, MA, CART, LPC
• Roderick Dallon Maxwell, DO
• Teresa Maxwell

• Plastic Surgery Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Plastic Surgery Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.