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Organization
BRUCE R MADDERN MD PA
Active
Organization
BRUCE R MADDERN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE R MADDERN MD (PRESIDENT)
(904) 398-5437
Entity
Organization
Contact information
Practice address
10475 CENTURION PKWY N, SUITE 302, JACKSONVILLE, FL 32256-5003
(904) 398-5437
(904) 398-3077
Mailing address
10475 CENTURION PKWY N, SUITE 302, JACKSONVILLE, FL 32256-5003
(904) 398-5437
(904) 398-3077
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45553
BC/BS OF FL
—
01
—
8651
AV MED
FL
Enumeration date
02/08/2006
Last updated
09/07/2007
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