Provider Demographics
NPI:1447258660
Name:MADDOX, JAMES B (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MADDOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CLARA BARTON BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5740
Mailing Address - Country:US
Mailing Address - Phone:972-272-5555
Mailing Address - Fax:972-272-0317
Practice Address - Street 1:530 CLARA BARTON BLVD
Practice Address - Street 2:STE 200
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5740
Practice Address - Country:US
Practice Address - Phone:972-272-5555
Practice Address - Fax:972-272-0317
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6074207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-1708003OtherFED. EMPLOYER TAX ID NO.
TX0977316-02Medicaid
TXC18663Medicare UPIN
TX00CB69Medicare ID - Type UnspecifiedMEDICARE/BCBS NUMBER