Provider Demographics
NPI:1700849411
Name:MALLETTE, STEPHEN GUY (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GUY
Last Name:MALLETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 US HIGHWAY 31 S
Mailing Address - Street 2:SUITE F
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-3619
Mailing Address - Country:US
Mailing Address - Phone:259-771-1995
Mailing Address - Fax:256-771-1965
Practice Address - Street 1:707 US HIGHWAY 31 S
Practice Address - Street 2:SUITE F
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-3619
Practice Address - Country:US
Practice Address - Phone:256-771-1995
Practice Address - Fax:256-771-1965
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-841207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51522611OtherBLUE CROSS BLUE SHIELD AL