Provider Demographics
NPI:1891719647
Name:MALLETTE, LAWRENCE EDWARD (MD, PHD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EDWARD
Last Name:MALLETTE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 DRYDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1206
Mailing Address - Country:US
Mailing Address - Phone:713-851-5989
Mailing Address - Fax:713-529-6508
Practice Address - Street 1:8200 WEDNESBURY LN
Practice Address - Street 2:STE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:713-271-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4891207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140245520Medicaid
TX00AJ67OtherBLUE CROSS/BLUE SHIELD
TX140245520Medicaid
TX0054ATMedicare ID - Type Unspecified