Application & Related Forms:

Please find our Provider Packet and Skills Checklist forms to begin the application process offline. Upon receipt of your application here at Maxim, our Credentialing Department will perform the standard verifications of licenses, past experience, and references. If you have any questions, please contact our physician consultants.

Provider Packet: 

Physician Application  

CRNA Application  

Background Release Form  

Malpractice Claim Form  

NPI Acknowledgement Form  

W-9 Form  

Direct Deposit  

Code of Conduct Reading Material and Acknowledgement Form  

Code of Compliance Reading Material and Acknowledgement Form  


Skills Checklists: 

Anesthesiologist  

Cardiology  

CRNA  

Dentistry  

Dermatology  

Emergency  

Family Practice with OB  

General Surgery  

Internal Medicine  

Neonatology  

Neurology  

Nuclear Medicine  

OBGYN  

Occupational Medicine  

Orthopedic Surgery  

Otorhinolaryngology  

Pathology  

Pediatrics  

PMR  

Podiatry  

Psychiatry  

Psychology  

Radiation Oncology  

Radiology  

Thoracic and Cardiovascular Surgery  

Urology  

Vascular Surgery  


Questions? Contact us via Mail, Phone or Email:

Maxim Physician Resources
5001 LBJ Freeway
Suite 900
Dallas, TX 75244
Phone: (888) 800-1853
Email: mprmanagement@maxhealth.com