MEDICARE: DR. J MICHAEL MALONEY III 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	174400000X	Specialist	24723	CO
2	207N00000X	Dermatology Physician	24723	CO

General Provider Information

NPI Number	:	1841201829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J MICHAEL MALONEY III MD

Provider Business Mailing Address
First Line	:	3773 CHERRY CREEK NORTH DR
Second Line	:	SUITE 970
City	:	DENVER
State	:	CO
Zip	:	80209-3804
Country	:	US
Telephone Number	:	303-388-5629
Fax Number	:	303-321-7586

Provider Business Practice Location Address
First Line	:	3773 CHERRY CREEK NORTH DR
Second Line	:	SUITE 970
City	:	DENVER
State	:	CO
Zip	:	80209-3804
Country	:	US
Telephone Number	:	303-388-5629
Fax Number	:	303-321-7586

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	12/16/2011

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