Healthcare Provider Details

I. General information

NPI: 1528122256
Provider Name (Legal Business Name): JOHN SPECHT MADDOX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

3823 RODMAN ST NW APT E23
WASHINGTON DC
20016-2816
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-2201
  • Fax:
Mailing address:
  • Phone: 240-506-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0089752
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberD0089752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: