Provider Demographics
NPI:1174919583
Name:BURCH, MAXWELL ANDERSON (MD)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:ANDERSON
Last Name:BURCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9617 GULF RESEARCH LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4560
Mailing Address - Country:US
Mailing Address - Phone:239-418-0999
Mailing Address - Fax:239-418-0091
Practice Address - Street 1:9617 GULF RESEARCH LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4555
Practice Address - Country:US
Practice Address - Phone:239-418-0999
Practice Address - Fax:239-274-0773
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL145151207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty