Provider Demographics
NPI:1992741193
Name:MALONE, GARY L (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:MALONE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1450 HUGHES ROAD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7356
Mailing Address - Country:US
Mailing Address - Phone:817-481-2767
Mailing Address - Fax:817-251-9544
Practice Address - Street 1:1450 HUGHES ROAD
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7356
Practice Address - Country:US
Practice Address - Phone:817-481-2767
Practice Address - Fax:817-251-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2020-11-12
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Provider Licenses
StateLicense IDTaxonomies
TXF42382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0334534Medicaid