Bruce Robert Maddern, MD

Primary specialty

Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X

License

ME0056292 Issued in FL

Practice address

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

Phone

(904) 398-5437

Fax

(904) 398-3077

NPI assigned

Feb 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1528030418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 DR MARTIN LUTHER KING JR ST N",
            "address_2": "STE. 108",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337011547",
            "telephone_number": "727-456-4250",
            "fax_number": "727-346-1044"
        },
        {
            "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": {
        "last_name": "MADDERN",
        "first_name": "BRUCE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "FL",
            "license": "ME0056292",
            "primary": true
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "FL",
            "license": "ME0056292",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0205114006",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2218700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "061886100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2759499",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "08675",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "12056336",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AV MED",
            "identifier": "203211",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Srirekha Reddy Madadi, M.D.
• Catherine Madaffari, MD
• Ansley Caroline Madala, MD
• Jennifer Maria Madden-Askew, D.D.S.
• Kate McDowell Madden, NP
• Charles B Maddix, APRN, MSN, PMHNP-BC
• Jennifer J Maddox, CRNA
• Karen B Maddox, MA
• Lisa Jeanne Maddox
• Supradeep Shree Venkata Madduri

• 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 Jun 25, 2014; 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.