Maddox, John Mark
Maddox, John Mark is an individual health care provider with primary practice located at 1145 Broadway Ste 300 , Tacoma WA 98402-3523. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Colon & Rectal Surgery. Allopathic & Osteopathic Physicians / Colon & Rectal Surgery is his primary health care specialty. Maddox, John Mark can be contacted via phone (253) 403-1130.Contact Information
Primary practice address
1145 Broadway Ste 300
Tacoma WA 98402-3523
Phone: (253) 403-1130
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 133071 | California |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | MD24744 | Oregon |
| Allopathic & Osteopathic Physicians / Colon & Rectal Surgery | 208C00000X | 133071 | California |
| Allopathic & Osteopathic Physicians / Colon & Rectal Surgery | 208C00000X | MD24744 | Oregon |
| Allopathic & Osteopathic Physicians / Colon & Rectal Surgery | 208C00000X | MD60662688 | Washington |
Profile Details
| NPI number | 1104801208 |
|---|---|
| LBN Legal business name | Maddox, John Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 12th, 2005 |
| Last updated | Dec 7th, 2022 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104801208 | NPPES |
| Oregon | MEDICAID | 297589 |
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