Healthcare Provider Details

I. General information

NPI: 1932168150
Provider Name (Legal Business Name): PHILIP A MADDOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 FRANKLIN ST
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

927 FRANKLIN ST
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-2728
  • Fax: 256-428-3423
Mailing address:
  • Phone: 256-539-2728
  • Fax: 256-428-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number10489
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number10489
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: