Provider Demographics
NPI:1609971605
Name:MADDOX, PATRICK TATE (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:TATE
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:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:80 DOCTORS DR STE 2
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7289
Practice Address - Country:US
Practice Address - Phone:828-650-2748
Practice Address - Fax:828-650-2799
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1576208600000X
NC2012-01668207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCQ390BOtherMEDICARE PTAN
NCQ00321928OtherRAILROAD PTAN