Provider Demographics
NPI:1114212347
Name:MADDOX, GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
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 1:550 16TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5699
Mailing Address - Country:US
Mailing Address - Phone:917-733-6740
Mailing Address - Fax:
Practice Address - Street 1:550 16TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5699
Practice Address - Country:US
Practice Address - Phone:206-324-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60224904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine