Provider Demographics
NPI:1750323796
Name:MALONE, DONALD WALTER (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:WALTER
Last Name:MALONE
Suffix:
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 1:2324 W. PIERCE ST.
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-628-5051
Mailing Address - Fax:575-887-0414
Practice Address - Street 1:2402 W. PIERCE ST., SUITE 6E
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220
Practice Address - Country:US
Practice Address - Phone:575-628-0312
Practice Address - Fax:575-628-8015
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23602207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK23602OtherOK LICENSE
OKP00345588OtherRAILROAD-MEDICARE
OKP00345588OtherRAILROAD PIN
OK2868440001OtherDME MEDICARE
OKMD100150330AMedicaid
OK611415200OtherFEDERAL WC-OW
NM90179854Medicaid
OKMD100150330AMedicaid
OKC18718Medicare UPIN
OK249620101Medicare PIN
OK611415200OtherFEDERAL WC-OW