Provider Demographics
NPI:1346603974
Name:MADDUX, CHARLES GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GREGORY
Last Name:MADDUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 LITTLE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8752
Mailing Address - Country:US
Mailing Address - Phone:360-416-6735
Mailing Address - Fax:360-424-6954
Practice Address - Street 1:11332 MOUNTAIN VIEW AVE STE C
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-6131
Practice Address - Fax:909-558-0430
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61051076207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program