Provider Demographics
NPI:1770539991
Name:MAXOOD, S STEVEN (MD)
Entity type:Individual
Prefix:
First Name:S
Middle Name:STEVEN
Last Name:MAXOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0032
Mailing Address - Country:US
Mailing Address - Phone:509-522-5731
Mailing Address - Fax:509-522-5747
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-522-5731
Practice Address - Fax:509-522-5747
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039933207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00039933OtherSTATE LICENSE NUMBER
WA0149754OtherLABOR AND INDUSTRY
WA110228191OtherRAILROAD MEDICARE
WA8277857Medicaid
WAG8900625Medicare PIN
WA110228191OtherRAILROAD MEDICARE
WAAB22552Medicare PIN