John Mark Maddox, M.D.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

MD60662688 Issued in WA

Practice address

1145 Broadway Ste 300
Tacoma, WA 98402-3523

Phone

(253) 403-1130

NPI assigned

Dec 12, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Surgical Care, LLC

  • Multi-Specialty Clinic/Center
  • Bend, OR
  • NPI 1225061724
  NPD (past)
• Cardiovascular Consultants of the Cascades LLP

  dba Heart Center Cardiology

  • Cardiovascular Disease Physician
  • Bend, OR
  • NPI 1376573279
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1104801208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 BROADWAY STE 300",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 BROADWAY STE 300",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023523",
            "telephone_number": "253-403-1130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDOX",
        "first_name": "JOHN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-12",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "133071",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OR",
            "license": "MD24744",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "CA",
            "license": "133071",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "OR",
            "license": "MD24744",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "WA",
            "license": "MD60662688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "297589",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawn Allen Macleod, MD
• Cory Harmon Macnulty, PH.D.
• William Kirk Macnulty, PH.D.
• Elisabeth A Madayag
• Sandra L Madden, RN, CDE
• Cielo Madera
• Christine Madick
• Madigan Army Medical Center
• Madigan Army Medical Center
• Madigan Army Medical Center

• Colon & Rectal Surgery Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Colon & Rectal Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.