Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 1105 | TX |
Y | 222Z00000X | Podiatrist | 1105 | TX |
N | 213ES0131X | Foot Surgery | 1105 | TX |
NPI | 1265523138 |
---|---|
Provider Name | Thomas W Madden |
First Address | Killeen, TX 76549-5954 |
Second Address | Killeen, TX 76549-5954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 02/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104077-01 | (05) | TX |
U13827 | (02) | TX |