Provider Demographics
NPI:1013190263
Name:MALONE, BRENDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:MALONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:CA
Mailing Address - Zip Code:94514-0324
Mailing Address - Country:US
Mailing Address - Phone:209-836-4417
Mailing Address - Fax:209-836-4417
Practice Address - Street 1:23233 LOS RANCHOS DR
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95304-9761
Practice Address - Country:US
Practice Address - Phone:209-836-4417
Practice Address - Fax:209-836-4417
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48361208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51020Medicare UPIN
CA00G483610Medicare PIN