Provider Demographics
NPI:1548420722
Name:MADDEN, GEORGE WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WESLEY
Last Name:MADDEN
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 1:4221 S WESTERN AVE
Mailing Address - Street 2:#2010
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3447
Mailing Address - Country:US
Mailing Address - Phone:405-644-5120
Mailing Address - Fax:405-644-5309
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:#2010
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-5120
Practice Address - Fax:405-644-5309
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26357207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK355777YSGZMedicare PIN