Individual
DR. JAN PAUL MADDOX
Active
Individual
DR. JAN PAUL MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
A26683
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A320460
MEDI-CAL
CA
01
—
ZZZ05981Z
BLUE SHIELD ID
CA
Enumeration date
06/14/2005
Last updated
11/19/2007
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