Individual
JAMES STEPHEN MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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