Individual
DR. BRUCE ROBERT MADDERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10475 CENTURION PKWY N, SUITE 302, JACKSONVILLE, FL 32256-5003
(904) 398-5437
(904) 398-3077
Mailing address
1033 DR MARTIN LUTHER KING JR ST N, STE. 108, ST PETERSBURG, FL 33701-1547
(727) 456-4250
(727) 346-1044
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
ME0056292
FL
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
ME0056292
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0205114006
CIGNA
FL
05
—
061886100
—
FL
01
—
08675
BCBS
FL
01
—
12056336
MULTIPLAN
FL
01
—
203211
AV MED
FL
01
—
2218700
AETNA
FL
01
—
P2759499
OXFORD
FL
Enumeration date
02/03/2006
Last updated
06/25/2014
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