Individual
JAMES STEPHEN MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
286 MITYLENE PARK DR, MONTGOMERY, AL 36117-3548
(334) 396-1555
(334) 396-9833
Mailing address
PO BOX 241627, MONTGOMERY, AL 36124-1627
(334) 396-1555
(334) 396-9833
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
10825
AL
207N00000X
Dermatology Physician
N5894
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45-3970660
FED TAX #
—
01
—
510-11674
BLUE CROSS
AL
01
—
511-30219
BCBS
AL
05
—
528501290
—
AL
01
—
631066099
FED TAX #
AL
01
—
CM4358
RR MCR
AL
Enumeration date
09/25/2006
Last updated
01/09/2013
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