Healthcare Provider Details

I. General information

NPI: 1265534226
Provider Name (Legal Business Name): DAVID A MADDOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FAIRVIEW CT
EMINENCE KY
40019-1158
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-845-5672
  • Fax: 502-845-1402
Mailing address:
  • Phone: 502-845-5672
  • Fax: 502-845-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25251
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25251
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: