Individual
JEREMY LINDSEY MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1/1 BAS 53 AREA, CAMP PENDLETON, CA 92055-5412
(760) 763-1831
Mailing address
PO BOX 555412, CAMP PENDLETON, CA 92055-5412
(760) 763-1831
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/20/2014
Last updated
05/20/2014
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