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General NPI Number Information
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NPI Number | 1346210713
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Entity Type | Individual
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Provider Name | CRAIG LYNN MADDOX M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | BROOKE ARMY MEDICAL CENTER MCHE-QD (CREDS)
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City | SAN ANTONIO
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State | TX
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Zip | 78234-6263
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Country | US
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Telephone | 210-916-2027
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Fax |
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Provider Business Mailing Address
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Address Line | 4970 AUGUSTA SQ
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City | SAN ANTONIO
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State | TX
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Zip | 78247-5670
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Country | US
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Telephone | 210-292-5373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 01060361A
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License Number State | IN
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