Provider Demographics
NPI:1194894261
Name:MADDOX, THOMAS GERALD (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GERALD
Last Name:MADDOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4620 J C NICHOLS PKWY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1617
Mailing Address - Country:US
Mailing Address - Phone:816-960-0300
Mailing Address - Fax:816-960-0446
Practice Address - Street 1:4620 J C NICHOLS PKWY
Practice Address - Street 2:SUITE 405
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1617
Practice Address - Country:US
Practice Address - Phone:816-960-0300
Practice Address - Fax:816-960-0446
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR5F37207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC52025Medicare UPIN