Dr. Bruce Robert Maddern
Pediatric Otolaryngology Otolaryngology/Facial Plastic Surgery
10475 Centurion Pkwy N Suite 302
Jacksonville
, Florida 32256-5003
Dr. Bruce Robert Maddern
Pediatric Otolaryngology Otolaryngology/Facial Plastic Surgery
10475 Centurion Pkwy N Suite 302
Jacksonville
, Florida 32256-5003
(727) 346-1044
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About
Features
Specialties
- Pediatric Otolaryngology
- Otolaryngology/Facial Plastic Surgery
Languages spoken
- English
Location
First Address
- Dr. Bruce Robert Maddern
- 1033 Dr Martin Luther King Jr St N Ste. 108
- St Petersburg, FL
- Zip : 33701-1547
- Fax : (727) 346-1044
- Phone : (727) 456-4250
Second Address
- Dr. Bruce Robert Maddern
- 10475 Centurion Pkwy N Suite 302
- Jacksonville, FL
- Zip : 32256-5003
- Fax : (904) 398-3077
- Phone : (904) 398-5437
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YP0228X | Pediatric Otolaryngology | ME0056292 | FL |
| N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME0056292 | FL |
National Provider Identifier
| NPI | 1528030418 |
|---|---|
| Provider Name | Dr. Bruce Robert Maddern |
| First Address | St Petersburg, FL 33701-1547 |
| Second Address | Jacksonville, FL 32256-5003 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/02/2006 |
| Last Update Date | 25/06/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 0205114006 | CIGNA (01) | FL |
| 061886100 | (05) | FL |
| 08675 | BCBS (01) | FL |
| 12056336 | MULTIPLAN (01) | FL |
| 203211 | AV MED (01) | FL |
| 2218700 | AETNA (01) | FL |
| B41875 | (02) | |
| P2759499 | OXFORD (01) | FL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.