Organization
D. MADDOX, M.D., A PROF. CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENIS ERIC MADDOX M.D. (PRESIDENT)
(661) 326-1100
Entity
Organization
Contact information
Practice address
2901 SILLECT AVE STE 200, BAKERSFIELD, CA 93308-6370
(661) 326-1100
Mailing address
2901 SILLECT AVE STE 200, BAKERSFIELD, CA 93308-6370
(661) 326-1100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G24697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G246970
—
CA
01
—
DN8120
GROUP RAILROAD
CA
01
—
ZZZ05742Z
MEDICARE PTAN
CA
Enumeration date
08/24/2007
Last updated
04/20/2009
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