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General NPI Number Information
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NPI Number | 1649535824
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Entity Type | Individual
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Provider Name | NICHOLAS MADAFFER D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-2700
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Fax | 573-815-3693
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Provider Business Mailing Address
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Address Line | 1600 E BROADWAY
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City | COLUMBIA
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State | MO
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Zip | 65201-5844
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Country | US
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Telephone | 573-815-2700
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Fax | 573-815-3693
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2017012404
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2017012404
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 252846
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4665-850
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 301480
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License Number State | LA
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