Provider Demographics
NPI:1891193223
Name:MADDOX, DENNIS (RRT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:MADDOX
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RESPIRATORY THERAPIS
Mailing Address - Street 1:1212 SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-2758
Mailing Address - Country:US
Mailing Address - Phone:337-396-3851
Mailing Address - Fax:
Practice Address - Street 1:1212 SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-2758
Practice Address - Country:US
Practice Address - Phone:337-396-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALT 2022227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered