Provider Demographics
NPI:1710917273
Name:MALNAR, GARRY BERNARD (DO)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:BERNARD
Last Name:MALNAR
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:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-7466
Mailing Address - Country:US
Mailing Address - Phone:812-882-6717
Mailing Address - Fax:812-882-8620
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-882-6717
Practice Address - Fax:812-882-8620
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000859A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200132850Medicaid
IN443010LLMedicare PIN
IN200132850Medicaid