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Individual
JEREMIAH J MADDOX
Active
Individual
JEREMIAH J MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
27935
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112729A
—
GA
05
—
003112729B
—
GA
01
—
1245449800
MEDICARE ID
AL
05
—
130085
—
AL
05
—
130087
—
AL
01
—
511-17847
BCBS OF AL - RCC
AL
01
—
511-18371
BCBS OF AL - HEALTHWEST
AL
Enumeration date
05/21/2007
Last updated
11/20/2014
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