Maddern, Bruce Robert

Maddern, Bruce Robert is an individual health care provider with primary practice located at 10475 Centurion Pkwy N Suite 302, Jacksonville FL 32256-5003. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Otolaryngology, Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery. Allopathic & Osteopathic Physicians / Pediatric Otolaryngology is his primary health care specialty. Maddern, Bruce Robert can be contacted via phone (904) 398-5437.

Contact Information

Primary practice address
10475 Centurion Pkwy N Suite 302 Jacksonville FL 32256-5003
Phone: (904) 398-5437
Fax: (904) 398-3077
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Otolaryngology 207YP0228X ME0056292 Florida
Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery 207YX0905X ME0056292 Florida

Profile Details

NPI number 1528030418
LBN Legal business name Maddern, Bruce Robert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 3rd, 2006
Last updated Jun 25th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528030418 NPPES
Florida Other 0205114006 CIGNA
Florida Other 2218700 CIGNA
Florida MEDICAID 061886100 CIGNA
Florida Other P2759499 CIGNA
Florida Other 08675 CIGNA
Florida Other 12056336 CIGNA
Florida Other 203211 CIGNA

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