Healthcare Provider Details

I. General information

NPI: 1912952136
Provider Name (Legal Business Name): MATTHEW T MALONE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 E TANGERINE RD
ORO VALLEY AZ
85755-6213
US

IV. Provider business mailing address

1551 E TANGERINE RD
ORO VALLEY AZ
85755-6213
US

V. Phone/Fax

Practice location:
  • Phone: 520-901-3539
  • Fax: 520-901-3654
Mailing address:
  • Phone: 520-901-3539
  • Fax: 520-901-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number5794
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: