Provider Demographics
NPI:1144681255
Name:MAXFIELD, LUKE (DO)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:MAXFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10298 WALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-5152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:412-712-8567
Practice Address - Street 1:607 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2603
Practice Address - Country:US
Practice Address - Phone:910-596-5421
Practice Address - Fax:412-712-8567
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-03771207N00000X, 207ND0101X
TN4372207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4372OtherSTATE LICENSE
NC2020-03771OtherSTATE LICENSE