Provider Demographics
NPI:1144267220
Name:DONALD W MALONE MD PC
Entity type:Organization
Organization Name:DONALD W MALONE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-380-1972
Mailing Address - Street 1:1705 N WASHINGTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2100
Mailing Address - Country:US
Mailing Address - Phone:580-380-1972
Mailing Address - Fax:580-920-8079
Practice Address - Street 1:1705 N WASHINGTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2100
Practice Address - Country:US
Practice Address - Phone:580-380-1972
Practice Address - Fax:580-920-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200087560AMedicaid
OK23602OtherOK LICENSE
OK611415200OtherFEDERAL WC-OW
OKDF1904OtherRAILROAD-MEDICARE
OK2868440001OtherDME MEDICARE
OKP00345588OtherRAILROAD PIN
OK100150330BOtherOSU MEDICAID ID #
OKP00345588OtherRAILROAD PIN
OK23602OtherOK LICENSE
OK=========001OtherBCBS GROUP #