Basic Information
| Provider Information | |||||||||
| NPI: | 1548420722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | WESLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 S WESTERN AVE | ||||||||
| Address2: | #2010 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056445120 | ||||||||
| FaxNumber: | 4056445309 | ||||||||
| Practice Location | |||||||||
| Address1: | 4221 S WESTERN AVE | ||||||||
| Address2: | #2010 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056445120 | ||||||||
| FaxNumber: | 4056445309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 06/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 26357 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 26357 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.