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General NPI Number Information
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NPI Number | 1972041531
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Entity Type | Individual
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Provider Name | BRANDON KYLE MADDOX D.V.M.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2017
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 11425 OVERSEAS HWY
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City | MARATHON
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State | FL
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Zip | 33050-3628
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Country | US
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Telephone | 305-743-6250
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Fax | 305-289-7389
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Provider Business Mailing Address
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Address Line | 11425 OVERSEAS HWY
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City | MARATHON
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State | FL
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Zip | 33050-3628
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Country | US
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Telephone | 305-743-6250
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Fax | 305-289-7389
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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 | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | VM-13981
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License Number State | FL
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