MEDICARE: DR. RANDOLPH AUGUSTUS MALONE IV M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	174400000X	Specialist	060041
3	207KA0200X	Allergy Physician	034412	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497726814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH AUGUSTUS MALONE IV M.D.

Provider Business Mailing Address
First Line	:	2804 REMINGTON GREEN CIR STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-1550
Country	:	US
Telephone Number	:	229-226-5616
Fax Number	:	229-226-7132

Provider Business Practice Location Address
First Line	:	2804 REMINGTON GREEN CIRCLE STE1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308
Country	:	US
Telephone Number	:	850-656-6269
Fax Number	:	850-877-5270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	03/17/2018

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