Healthcare Provider Details

I. General information

NPI: 1972972800
Provider Name (Legal Business Name): MARCUS MALONE MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 37TH PL SUITE #200
VERO BEACH FL
32960-4502
US

IV. Provider business mailing address

9611 N US HIGHWAY 1 SUITE #166
SEBASTIAN FL
32958-6363
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-3990
  • Fax: 772-581-3991
Mailing address:
  • Phone: 772-581-3990
  • Fax: 772-581-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081H0002X
TaxonomyHospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME99007
License Number StateFL

VIII. Authorized Official

Name: MARCUS MALONE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 772-581-3990