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General NPI Number Information
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NPI Number | 1336347020
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Entity Type | Individual
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Provider Name | MARTHA A MALONE DO
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Gender | Female
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 14520 E 104TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-4843
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Country | US
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Telephone | 918-695-1480
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Fax |
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Provider Business Mailing Address
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Address Line | 14520 E 104TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-4843
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4503
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 262251
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License Number State | NY
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