MEDICARE: STACEY MADDOX DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	128385	AK
2	207R00000X	Internal Medicine Physician	0116026994	VA

General Provider Information

NPI Number	:	1528472610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY MADDOX DO

Provider Business Mailing Address
First Line	:	PO BOX 31001-4162
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4162
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W NORTHERN LIGHTS BLVD STE A
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3652
Country	:	US
Telephone Number	:	907-212-3420
Fax Number	:	907-212-5550

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	04/24/2026

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Directions to “ STACEY MADDOX DO” Practice Location

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