Provider Demographics
NPI:1972041531
Name:MADDOX, BRANDON KYLE (DVM)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KYLE
Last Name:MADDOX
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11425 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3628
Mailing Address - Country:US
Mailing Address - Phone:305-743-6250
Mailing Address - Fax:305-289-7389
Practice Address - Street 1:11425 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3628
Practice Address - Country:US
Practice Address - Phone:305-743-6250
Practice Address - Fax:305-289-7389
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLVM-13981405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional