MEDICARE: CHARLES BRUCE MALONE III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	E7660	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538164306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BRUCE MALONE III MD

Provider Business Mailing Address
First Line	:	1015 E 32ND ST
Second Line	:	STE 101
City	:	AUSTIN
State	:	TX
Zip	:	78705-2700
Country	:	US
Telephone Number	:	512-477-6341
Fax Number	:	512-477-1148

Provider Business Practice Location Address
First Line	:	1015 E 32ND ST
Second Line	:	STE 101
City	:	AUSTIN
State	:	TX
Zip	:	78705-2700
Country	:	US
Telephone Number	:	512-477-6341
Fax Number	:	512-477-1148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/08/2014

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