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General NPI Number Information
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NPI Number | 1457422628
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Entity Type | Organization
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Legal Business Name | DWIGHT W. MALONE, M.D., INC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 5230 PACIFIC CONCOURSE DR 110
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City | LOS ANGELES
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State | CA
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Zip | 90045-6200
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Country | US
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Telephone | 323-779-2800
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Fax | 323-754-4014
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Provider Business Mailing Address
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Address Line | 5230 PACIFIC CONCOURSE DR 110
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City | LOS ANGELES
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State | CA
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Zip | 90045-6200
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Country | US
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Telephone | 323-779-2800
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Fax | 323-754-4014
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Authorized Official
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Title or Position | MD
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Name | DWIGHT WAYNE MALONE
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Credential | M.D.
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Telephone | 323-779-2800
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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 | G71749
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License Number State | CA
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