Provider Demographics
NPI:1205222056
Name:MALONE, GARRY
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:MALONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8206 LETTIE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4722
Mailing Address - Country:US
Mailing Address - Phone:281-222-5832
Mailing Address - Fax:832-767-5732
Practice Address - Street 1:6720 BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-6412
Practice Address - Country:US
Practice Address - Phone:713-643-0433
Practice Address - Fax:832-767-5732
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor