Provider Demographics
NPI:1194962431
Name:MADDOX, ROBERT MCLEMORE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MCLEMORE
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 1:601 SUNLAND PARK DR
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5131
Mailing Address - Country:US
Mailing Address - Phone:915-881-8100
Mailing Address - Fax:
Practice Address - Street 1:601 SUNLAND PARK DR
Practice Address - Street 2:BUILDING 2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5131
Practice Address - Country:US
Practice Address - Phone:915-881-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7166207W00000X
NM89251207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology