DR. BRUCE ROBERT MADDERN (NPI# 1528030418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528030418 |
| Entity Type | Individual |
| Full Name | DR. BRUCE ROBERT MADDERN |
| Credential | MD |
| Practice Address |
10475 Centurion Pkwy N Suite 302 Jacksonville FL 32256-5003 |
| Mailing Address |
1033 Dr Martin Luther King Jr St N Ste. 108 St Petersburg FL 33701-1547 |
| Practice Telephone | 9043985437 |
| Practice Fax Number | 9043983077 |
| Mailing Telephone | 7274564250 |
| Mailing Fax Number | 7273461044 |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2014-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YP0228X |
Otolaryngology Specialization: Pediatric Otolaryngology |
ME0056292 | FL | Allopathic & Osteopathic Physicians |
| N | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
ME0056292 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBS | 08675 | 01 |
| FL | AETNA | 2218700 | 01 |
| FL | AV MED | 203211 | 01 |
| FL | OXFORD | P2759499 | 01 |
| FL | 061886100 | 05 | |
| FL | CIGNA | 0205114006 | 01 |
| FL | MULTIPLAN | 12056336 | 01 |
| Street Address |
10475 CENTURION PKWY N SUITE 302 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32256-5003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265438493 | James Douglas Green Jr. | Specialist | 10475 Centurion Pkwy N, Ste 303, Jacksonville, FL 32256-5003 | 2005-06-22 |
| 1285170282 | Kelli D. Williams | Physician Assistant | 10475 Centurion Pkwy N, Suite 104, Jacksonville, FL 32256-5003 | 2017-01-13 |
| 1235593641 | Ryan M Funderburk | Audiologist | 10475 Centurion Pkwy N, Suite 303, Jacksonville, FL 32256-5003 | 2016-04-12 |
| 1275998908 | Se Orthopedic Specialists | Non-Pharmacy Dispensing Site | 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 | 2015-12-23 |
| 1821479650 | Kristen Edenfield | Audiologist | 10475 Centurion Pkwy N, #303, Jacksonville, FL 32256-5003 | 2015-06-17 |
| 1952789547 | Christopher Perez De Corcho | Physical Therapist | 10475 Centurion Pkwy N, #304, Jacksonville, FL 32256-5003 | 2015-05-14 |
| 1588059083 | Krista L Boniecki | Physical Therapist | 10475 Centurion Pkwy N, Suie 220, Jacksonville, FL 32256-5003 | 2015-04-01 |
| 1679970990 | Paul D Sturney | Physician Assistant | 10475 Centurion Pkwy N, Suite 220, Jacksonville, FL 32256-5003 | 2014-12-02 |
| 1326440801 | Healthcore Wellness, P.a. | Chiropractor | 10475 Centurion Pkwy N, Suite 201, Jacksonville, FL 32256-5003 | 2014-09-16 |
| 1902213770 | Tonya Goodson | Nurse Practitioner | 10475 Centurion Pkwy N, #203, Jacksonville, FL 32256-5003 | 2014-07-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841890464 | Alice Sanchez | Dietitian, Registered | 7643 Gate Parkway, Suite 104-1128, Jacksonville, FL 32256 | 2020-11-01 |
| 1093327702 | Oaktree Dental LLC | Clinic/Center | 14595 Philips Highway, Jacksonville, FL 32256 | 2020-08-24 |
| 1538787866 | Tywanna Council | Massage Therapist | 4720 Salisbury Road #102, Jacksonville, FL 32256 | 2020-07-13 |
| 1275155368 | Christy Orellana | Social Worker | 5011 Gate Parkway Bldg 100 Suite 100, Jacksonville, FL 32256 | 2020-05-11 |
| 1376175117 | Diane Stover | Case Manager/Care Coordinator | 7001 A. C. Skinner Parkway, Jacksonville, FL 32256 | 2020-02-10 |
| 1982235859 | Sandra Josefina Baez Nunez | Nurse Practitioner | 10739 Deerwood Park Blvd, Suite 200, Jacksonville, FL 32256 | 2020-01-30 |
| 1205476496 | Point Meadows Dental Center, Inc. | Dentist | 10915 Baymeadows Rd, #106, Jacksonville, FL 32256 | 2020-01-15 |
| 1598324113 | Dhaval Yogeshkumar Shah | Dentist | 8206 Philips Hwy., Suite 21, Jacksonville, FL 32256 | 2019-06-07 |
| 1003472499 | Dade Medical, Inc. | Durable Medical Equipment & Medical Supplies | 9143 Philips Highway Suite 270, Jacksonville, FL 32256 | 2019-05-13 |
| 1003479726 | Nichole Bashara | Behavior Technician | 8383 Baymeadows Rd, Jacksonville, FL 32256 | 2019-04-18 |
| Find all providers in zip 32256 | ||||
| Taxonomy Code | 207YP0228X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Pediatric Otolaryngology |
| A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801902739 | Saswata Roy | Otolaryngology | 11705 San Jose Blvd, Ste 103, Jacksonville, FL 32223-1835 | 2006-08-22 |
| 1275588303 | Daniel L Wohl | Otolaryngology | 4114 Sunbeam Rd, Suite 403, Jacksonville, FL 32257-8847 | 2006-05-24 |
| 1275793358 | Angela Prevatt Black | Otolaryngology | 807 Childrens Way, Nemours Childrens Clinic, Jacksonville, FL 32207-8426 | 2008-06-12 |
| 1427254291 | Steven M. Andreoli | Otolaryngology | 807 Childrens Way, Nemours Childrens Clinic, Jacksonville, FL 32207-8426 | 2007-06-26 |
| 1447365424 | Denise A Sherman | Otolaryngology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2006-08-20 |
| 1144231671 | Gary D. Josephson | Otolaryngology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2006-08-10 |
| 1134191034 | Beverly Denise Mcmillin | Otolaryngology | 10475 Centurion Pkwy N, Suite 302, Jacksonville, FL 32256-5003 | 2006-02-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619389962 | Pediatric Ent of Southwest Florida Pllc | Otolaryngology | 19 Georgetown, Fort Myers, FL 33919-1088 | 2014-05-21 |
| 1508002072 | Pediatric Ent, LLC | Otolaryngology | 1499 S Harbor City Blvd Ste 303, Melbourne, FL 32901-3245 | 2009-01-05 |
| 1285888396 | Yamilet Tirado | Otolaryngology | 3100 S.w. 62nd Avenue, Suite 124, Miami, FL 33155 | 2008-11-17 |
| 1295928380 | Aiysha C Balbosa | Otolaryngology | 5830 Coral Ridge Dr Ste 140, Coral Springs, FL 33076-3388 | 2007-08-22 |
| 1801002100 | Kyle Leslie Bressler | Otolaryngology | 6754 Stonegate Dr, Naples, FL 34109-7224 | 2007-05-15 |
| 1114011707 | Karin Swisher Hotchkiss | Otolaryngology | 5105 N Armenia Ave, Tampa, FL 33603-1405 | 2006-10-03 |
| 1568554400 | Scott Brietzke | Otolaryngology | 1131 N 35th Ave Ste 300, Hollywood, FL 33021 | 2006-09-29 |
| 1669573028 | Kathleen M Wasylik | Otolaryngology | 601 5th St. South, #701, St Petersburg, FL 33701 | 2006-09-26 |
| 1487628251 | David L Mandell | Otolaryngology | 10150 Hagen Ranch Road, Suite 100, Boynton Beach, FL 33437 | 2006-02-16 |
| 1649242538 | David Joel Malis | Otolaryngology | 1499 S Harbor City Blvd, Suite 303, Melbourne, FL 32901-3245 | 2006-02-03 |
| Find all providers with the same taxonomy | ||||
| City | JACKSONVILLE |
| Zip Code | 32256 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.