Healthcare Provider Details

I. General information

NPI: 1689895534
Provider Name (Legal Business Name): JUSTIN ALAN MALONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/13/2025
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HOSPITAL DRIVE
OSAGE BEACH MO
65065
US

IV. Provider business mailing address

54 HOSPITAL DRIVE
OSAGE BEACH MO
65065
US

V. Phone/Fax

Practice location:
  • Phone: 573-302-2714
  • Fax: 573-302-2713
Mailing address:
  • Phone: 573-302-2714
  • Fax: 573-302-2713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2006001558
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2006001558
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2006001558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: