Provider Demographics
NPI:1467447144
Name:DR.'S BLAUM & MADDOX
Entity Type:Organization
Organization Name:DR.'S BLAUM & MADDOX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-990-8181
Mailing Address - Street 1:8076B SPRING RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3854
Mailing Address - Country:US
Mailing Address - Phone:251-990-8181
Mailing Address - Fax:251-990-8181
Practice Address - Street 1:8076B SPRING RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3854
Practice Address - Country:US
Practice Address - Phone:251-990-8181
Practice Address - Fax:251-990-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01448404OtherUNITED CONCORDIA
AL51522336OtherBLUE CROSS BLUE SHEILD