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General NPI Number Information
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NPI Number | 1760839211
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Entity Type | Individual
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Provider Name | JACOB MADDUX M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2016
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 15331 W BELL RD STE 308310
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City | SURPRISE
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State | AZ
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Zip | 85374-4102
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Country | US
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Telephone | 602-843-2991
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Fax | 602-978-1226
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Provider Business Mailing Address
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Address Line | 13400 E SHEA BLVD
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-5452
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Country | US
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Telephone | 480-301-8000
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R75864
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 55863
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License Number State | AZ
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