Individual
DR. JOHN MARK MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1145 BROADWAY STE 300, TACOMA, WA 98402-3523
(253) 403-1130
Mailing address
1145 BROADWAY STE 300, TACOMA, WA 98402-3523
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
133071
CA
208600000X
Surgery Physician
MD24744
OR
208C00000X
Colon & Rectal Surgery Physician
133071
CA
208C00000X
Colon & Rectal Surgery Physician
MD24744
OR
208C00000X
Colon & Rectal Surgery Physician
Primary
MD60662688
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297589
—
OR
Enumeration date
12/12/2005
Last updated
12/07/2022
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