Provider Demographics
NPI:1538132022
Name:MALONE, DANIEL JR (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MALONE
Suffix:JR
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:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:705-854-3160
Mailing Address - Fax:702-854-3211
Practice Address - Street 1:5580 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0111
Practice Address - Country:US
Practice Address - Phone:702-854-3160
Practice Address - Fax:702-854-3211
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1538132022Medicaid
NV2002627Medicaid
NVVMD5241Medicare PIN
NVFS973ZMedicare PIN
NV1538132022Medicaid
NVMD5241Medicare PIN