Individual
JOHN L. MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 S ELISEO DR STE 207, GREENBRAE, CA 94904-2015
(415) 925-0550
(415) 925-9062
Mailing address
1300 S ELISEO DR STE 207, GREENBRAE, CA 94904-2015
(415) 925-0550
(415) 925-9062
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G40606
CA
207NP0225X
Pediatric Dermatology Physician
G40606
CA
207NS0135X
Procedural Dermatology Physician
G40606
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G406060
—
CA
Enumeration date
01/18/2007
Last updated
07/01/2015
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