Provider Demographics
NPI:1942278742
Name:MALLETTE, JAMES E JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:MALLETTE
Suffix:JR
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 1:216 MARENGO ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6012
Mailing Address - Country:US
Mailing Address - Phone:256-767-1701
Mailing Address - Fax:256-760-0496
Practice Address - Street 1:216 MARENGO ST
Practice Address - Street 2:SUITE H
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6012
Practice Address - Country:US
Practice Address - Phone:256-767-1701
Practice Address - Fax:256-760-0496
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00006531174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003900Medicaid
C73676Medicare UPIN
AL000003900Medicare ID - Type Unspecified