Provider Demographics
NPI:1265523138
Name:MADDEN, THOMAS W (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:MADDEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 S CLEAR CREEK RD STE 109
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-5954
Mailing Address - Country:US
Mailing Address - Phone:254-634-3668
Mailing Address - Fax:254-634-0278
Practice Address - Street 1:4102 S CLEAR CREEK RD STE 109
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5954
Practice Address - Country:US
Practice Address - Phone:254-634-3668
Practice Address - Fax:254-634-0278
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1105213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104077-01Medicaid
TX00R35MMedicare ID - Type Unspecified
TX1104077-01Medicaid
TXU13827Medicare UPIN