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NPI Code Detail

MEDICARE: DR. CAROL ELIZABETH MALLETTE M.D.

MEDICARE: DR. CAROL ELIZABETH MALLETTE 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
1207RG0100XGastroenterology PhysicianM3308TX

General Provider Information

NPI Number : 1558300756
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL ELIZABETH MALLETTE M.D.
Provider Business Mailing Address
First Line : PO BOX 35629
Second Line :
City : DALLAS
State : TX
Zip : 75235-0629
Country : US
Telephone Number : 214-424-2200
Fax Number :
Provider Business Practice Location Address
First Line : 6317 HARRIS PKWY STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4258
Country : US
Telephone Number : 817-361-6900
Fax Number : 817-522-1968
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 01/09/2024

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