Provider Demographics
NPI:1053572966
Name:MAXFIELD, JASON LEE (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:MAXFIELD
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 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8688
Mailing Address - Fax:417-347-8393
Practice Address - Street 1:931 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2878
Practice Address - Country:US
Practice Address - Phone:417-347-8688
Practice Address - Fax:417-347-8693
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013019945207RS0012X, 207QS1201X, 2084S0012X
IAR-83782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine