Provider Demographics
NPI:1922097146
Name:MADDOX, DENIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:E
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 1:2901 SILLECT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6371
Mailing Address - Country:US
Mailing Address - Phone:661-323-8384
Mailing Address - Fax:661-323-9326
Practice Address - Street 1:2901 SILLECT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6371
Practice Address - Country:US
Practice Address - Phone:661-323-8384
Practice Address - Fax:661-323-9326
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24697174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G246970Medicaid
CAZZZ05742ZOtherMEDICARE PROVIDER ID
CAZZZ05742ZMedicare PIN
CAZZZ05742ZOtherMEDICARE PROVIDER ID
CA00G246970Medicare ID - Type Unspecified
CA060060318Medicare PIN
CAZZZ84391ZMedicare PIN