Provider Demographics
NPI:1104405422
Name:MADDOX, RYAN PEYTON (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PEYTON
Last Name:MADDOX
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 1:4000 LINWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7224
Mailing Address - Country:US
Mailing Address - Phone:870-239-8503
Mailing Address - Fax:
Practice Address - Street 1:4000 LINWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7224
Practice Address - Country:US
Practice Address - Phone:870-239-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-16646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine