Healthcare Provider Details

I. General information

NPI: 1285657791
Provider Name (Legal Business Name): BERNARD THOMAS MALONE JR. M.S., R.D., L.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST NUTRITION & FOOD SERVICE (120)
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

26315 REYGLEN DR
SAN ANTONIO TX
78255-3548
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5118
  • Fax: 210-949-3299
Mailing address:
  • Phone: 210-698-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT03025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: