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General NPI Number Information
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NPI Number | 1174716997
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Entity Type | Organization
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Legal Business Name | D. MADDOX, M.D., A PROF. CORP
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 2901 SILLECT AVE STE 200
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City | BAKERSFIELD
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State | CA
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Zip | 93308-6370
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Country | US
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Telephone | 661-326-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 2901 SILLECT AVE STE 200
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City | BAKERSFIELD
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State | CA
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Zip | 93308-6370
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Country | US
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Telephone | 661-326-1100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENIS ERIC MADDOX
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Credential | M.D.
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Telephone | 661-326-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G24697
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License Number State | CA
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