Provider Demographics
NPI:1780955708
Name:GARY L MALONE MD PA
Entity type:Organization
Organization Name:GARY L MALONE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-481-2767
Mailing Address - Street 1:1450 HUGHES RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7359
Mailing Address - Country:US
Mailing Address - Phone:817-481-2767
Mailing Address - Fax:817-251-9544
Practice Address - Street 1:1450 HUGHES RD
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7359
Practice Address - Country:US
Practice Address - Phone:817-481-2767
Practice Address - Fax:817-251-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF42382084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty