Provider Demographics
NPI:1063679165
Name:HADDOX, JAMES DAVID (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:HADDOX
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:23 CHADWICK CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-4208
Mailing Address - Country:US
Mailing Address - Phone:203-445-9041
Mailing Address - Fax:203-445-9052
Practice Address - Street 1:23 CHADWICK CT
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-4208
Practice Address - Country:US
Practice Address - Phone:203-445-9041
Practice Address - Fax:203-445-9052
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.21660207LP2900X
WI26985-020207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB42769Medicare UPIN