Provider Demographics
NPI:1982667515
Name:MADDALON, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:MADDALON
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 1:721 W ROBERTSON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4934
Mailing Address - Country:US
Mailing Address - Phone:813-684-3707
Mailing Address - Fax:813-643-2457
Practice Address - Street 1:721 W ROBERTSON ST
Practice Address - Street 2:STE 102
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4934
Practice Address - Country:US
Practice Address - Phone:813-684-3707
Practice Address - Fax:813-643-2457
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046498207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL206415OtherAVMED
FL1009622OtherCAREPLUS
FLP01184811OtherRAILROAD MEDICARE
FL041797100Medicaid
FL30811OtherBC/BS
FL0624161OtherAETNA
FL30811OtherBC/BS
FLD54134Medicare UPIN