Provider Demographics
NPI:1831319359
Name:MADDUX, ROBERT FINLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FINLEY
Last Name:MADDUX
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 88
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39043-0088
Mailing Address - Country:US
Mailing Address - Phone:601-824-0342
Mailing Address - Fax:601-824-0349
Practice Address - Street 1:3550 HIGHWAY 468 W
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193-5529
Practice Address - Country:US
Practice Address - Phone:601-351-8525
Practice Address - Fax:601-351-8586
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
MS102102084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07085229Medicaid
MS10210OtherSTATE LICENSE