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General NPI Number Information
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NPI Number | 1275519928
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Entity Type | Individual
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Provider Name | DEBORAH MALONE D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 4420 S HOPKINS AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780
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Country | US
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Telephone | 321-264-8644
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Fax | 321-264-8933
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS10835
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License Number State | FL
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