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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 4 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 1104801208 NPPES
Oregon MEDICAID 297589

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