Provider Demographics
NPI:1588002554
Name:MADDOX, BRIAN CURTIS (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CURTIS
Last Name:MADDOX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-875-7741
Mailing Address - Fax:228-575-2917
Practice Address - Street 1:90 INDUSTRIAL PARK CIR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5800
Practice Address - Country:US
Practice Address - Phone:228-822-6110
Practice Address - Fax:228-875-8048
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY03985207Q00000X
MS27950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine