Provider Demographics
NPI:1144467499
Name:ROBERT M. MADDOX, M.D., P.A.
Entity type:Organization
Organization Name:ROBERT M. MADDOX, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MCLEMORE
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-881-8100
Mailing Address - Street 1:601 SUNLAND PARK DR
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5131
Mailing Address - Country:US
Mailing Address - Phone:915-881-8100
Mailing Address - Fax:
Practice Address - Street 1:601 SUNLAND PARK DR
Practice Address - Street 2:BUILDING 2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5131
Practice Address - Country:US
Practice Address - Phone:915-881-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center