Bruce R Maddern MD PA

Primary specialty

Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X

Legal business name

BRUCE R MADDERN MD PA

Practice address

10475 Centurion Pkwy N
Suite 302
Jacksonville, FL 32256-5003

Phone

(904) 398-5437

Fax

(904) 398-3077

NPI assigned

Feb 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bruce R Maddern, MD

Title

President

Phone

(904) 398-5437

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189123200000",
    "number": "1225001589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N",
            "address_2": "SUITE 302",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565003",
            "telephone_number": "904-398-5437",
            "fax_number": "904-398-3077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N",
            "address_2": "SUITE 302",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565003",
            "telephone_number": "904-398-5437",
            "fax_number": "904-398-3077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE R MADDERN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2007-09-07",
        "status": "A",
        "authorized_official_last_name": "MADDERN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-398-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AV MED",
            "identifier": "8651",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF FL",
            "identifier": "45553",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Brownson
• Bryan K Brozy, PT, DPT
• Craig Brubaker, PHARMD
• Jeremy E Brubaker, D.C.
• Bruce a Hartwig MD PA
• Alison Bruce, MBCHB
• Barbara Bruce, PHD
• Charles Bruce, MD
• Robin Dee Bruce, MS, CCC-SLP
• Wendi Wallace Bruce, CCC/SLP

• Pediatric Otolaryngology Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; 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.