Provider Demographics
NPI:1720021280
Name:MALONE, DIANA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
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 4207
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-4207
Mailing Address - Country:US
Mailing Address - Phone:903-544-6780
Mailing Address - Fax:903-544-6799
Practice Address - Street 1:323 E HAWKINS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7905
Practice Address - Country:US
Practice Address - Phone:903-544-6780
Practice Address - Fax:903-544-6799
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-20032207Q00000X
NMMD2018-0897207Q00000X
CAC159199207Q00000X
ORMD190704207Q00000X
AK138925207Q00000X
TXL5820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine