Individual
ROBERT K MADDOCK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2553 BEVERLY ST, SALT LAKE CITY, UT 84106-3118
(801) 485-5445
Mailing address
2553 BEVERLY ST, SALT LAKE CITY, UT 84106-3118
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
148967-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148967-1205
PHYSICIAN & SURG LIC #
UT
Enumeration date
08/21/2006
Last updated
03/07/2023
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