Provider Demographics
NPI:1598082398
Name:MADDOX, KEVIN W (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:MADDOX
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20452
Mailing Address - Street 2:SOPA/APA CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:1921 STONECIPHER BLVD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-421-4570
Practice Address - Fax:614-442-2430
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2016-09-14
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Provider Licenses
StateLicense IDTaxonomies
OK5590207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology