Provider Demographics
NPI:1720233430
Name:TIMOTHY F. MALONE, DO, PA
Entity Type:Organization
Organization Name:TIMOTHY F. MALONE, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-341-8770
Mailing Address - Street 1:9603 WHITE ROCK TRL
Mailing Address - Street 2:#110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5012
Mailing Address - Country:US
Mailing Address - Phone:214-341-8770
Mailing Address - Fax:
Practice Address - Street 1:9603 WHITE ROCK TRL
Practice Address - Street 2:#110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5012
Practice Address - Country:US
Practice Address - Phone:214-341-8770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00320LMedicare PIN