Provider Demographics
NPI:1275590606
Name:MADDUX, HOLT BENJAMIN JR (MD)
Entity Type:Individual
Prefix:
First Name:HOLT
Middle Name:BENJAMIN
Last Name:MADDUX
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1325 WOLF PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1742
Mailing Address - Country:US
Mailing Address - Phone:901-252-3411
Mailing Address - Fax:901-384-6422
Practice Address - Street 1:1325 WOLF PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1742
Practice Address - Country:US
Practice Address - Phone:901-252-3400
Practice Address - Fax:901-682-0047
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN11107208800000X
MS16103208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
211159OtherSOUTHERN HEALTH SERVICES
115806OtherHEALTH LINK
12940170OtherPHCS
12940170OtherHEALTH ASSURANCE EPA
TN3007327Medicaid
85552OtherBLUE CROSS AR
TN0063189OtherBLUE CROSS
02110025300OtherQUAL CHOICE
4563452OtherAETNA
2596090OtherCIGNA
731661OtherFIRST HEALTH
02110025300OtherQUAL CHOICE
12940170OtherPHCS