Provider Demographics
NPI:1750569810
Name:MADDEN, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-965-5437
Mailing Address - Fax:314-965-5439
Practice Address - Street 1:9580 WATSON RD STE A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1539
Practice Address - Country:US
Practice Address - Phone:314-965-5437
Practice Address - Fax:314-965-5439
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005026245208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO342893OtherGHP
MO2725138OtherCIGNA
MO9310122OtherAETNA
MO906382OtherHEALTHLINK
MO2868804OtherUHC
MO000000561731OtherANTHEM BCBS