DR. JOHN MARK MADDOX M.D. NPI 1104801208

NPI Information

NPI: 1104801208
Provider Name: DR. JOHN MARK MADDOX, M.D.
Classification: Colon & Rectal Surgery - 208C00000X
Entity Type: Individual
Address:
1145 BROADWAY STE 300
TACOMA, WA
ZIP 98402
Phone: (253) 403-1130
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DR. John Mark Maddox, M.D. is a colon rectal surgery in Tacoma, WA. The provider is a colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. DR. John Mark Maddox, M.D. NPI is 1104801208. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1145 BROADWAY STE 300
TACOMA, WA
ZIP 98402-523
Phone: (253) 403-1130

The enumeration date for this NPI number is 12/12/2005 and was last updated on 12/7/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	208600000X	Surgery	133071	CALIFORNIA	No
2	208600000X	Surgery	MD24744	OREGON	No
3	208C00000X	Colon & Rectal Surgery	133071	CALIFORNIA	No
4	208C00000X	Colon & Rectal Surgery	MD24744	OREGON	No
5	208C00000X	Colon & Rectal Surgery	MD60662688	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	297589	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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