Provider Demographics
NPI:1538164306
Name:MALONE, CHARLES BRUCE III (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRUCE
Last Name:MALONE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2700
Mailing Address - Country:US
Mailing Address - Phone:512-477-6341
Mailing Address - Fax:512-477-1148
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2700
Practice Address - Country:US
Practice Address - Phone:512-477-6341
Practice Address - Fax:512-477-1148
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7660207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126497002Medicaid
TX010021908Medicare PIN
TX804433Medicare ID - Type UnspecifiedMEDICARE NUMBER
TX0349690001Medicare NSC
TX126497002Medicaid
TX0349690003Medicare NSC
TXC18713Medicare UPIN