Provider Demographics
NPI:1992585699
Name:MADDOX, BENJAMIN LEE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:MADDOX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 ITHACA ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-3116
Mailing Address - Country:US
Mailing Address - Phone:601-528-3361
Mailing Address - Fax:
Practice Address - Street 1:6908 ITHACA ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-3116
Practice Address - Country:US
Practice Address - Phone:601-528-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program