MEDICARE: DANIEL MALONE JR. MD

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	207R00000X	Internal Medicine Physician	5241	NV

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538132022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MALONE JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 15645
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5645
Country	:	US
Telephone Number	:	705-854-3160
Fax Number	:	702-854-3211

Provider Business Practice Location Address
First Line	:	5580 W FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-0111
Country	:	US
Telephone Number	:	702-854-3160
Fax Number	:	702-854-3211

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	01/18/2017

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