Provider Demographics
NPI:1568458958
Name:MADDOX, BARNEY T (MD)
Entity Type:Individual
Prefix:
First Name:BARNEY
Middle Name:T
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 1:811 W INTERSTATE 20
Mailing Address - Street 2:SUITE G22
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5870
Mailing Address - Country:US
Mailing Address - Phone:817-784-0818
Mailing Address - Fax:817-804-8176
Practice Address - Street 1:811 W INTERSTATE 20
Practice Address - Street 2:SUITE G22
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5870
Practice Address - Country:US
Practice Address - Phone:817-784-0818
Practice Address - Fax:817-804-8176
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4232208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123489009OtherMEDICAID OTHER
TX123489006Medicaid
TX123489010Medicaid
TX123489007Medicaid
TX123489008Medicaid
TXB24558Medicare UPIN
TX123489008Medicaid
TX8C2662Medicare PIN