Provider Demographics
NPI:1386757136
Name:MADDEN, GARY D (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:MADDEN
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 1:700 SOLOMON LANE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705
Mailing Address - Country:US
Mailing Address - Phone:432-699-2370
Mailing Address - Fax:432-697-3524
Practice Address - Street 1:2500 W ILLINOIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6339
Practice Address - Country:US
Practice Address - Phone:432-699-2370
Practice Address - Fax:432-697-3524
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3578207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123441101Medicaid
TXB24554Medicare UPIN
TX89430JMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE