Individual
JONATHAN PATMOR MADDUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
518 WEST GUM STREET, MARION, KY 42064-1516
(270) 965-5238
(270) 965-9015
Mailing address
PO BOX 559, MARION, KY 42064-0559
(270) 965-5238
(270) 965-9015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44671
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000723351
ANTHEM BLUE CROSS/BLUE SHIELD
KY
05
—
7100172480
—
KY
Enumeration date
01/09/2009
Last updated
10/13/2011
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