Individual
ANDRA E. MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
98 STATE HIGHWAY 150, SUITE 7, EL PRADO, NM 87529-1589
(575) 776-1117
(575) 776-1119
Mailing address
PO BOX 1589, EL PRADO, NM 87529-1589
(575) 776-1117
(575) 776-1119
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT8027
NM
Other
Enumeration date
08/25/2023
Last updated
08/25/2023
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