Provider Demographics
NPI:1457343113
Name:MALONE, JAMES MATHEW III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATHEW
Last Name:MALONE
Suffix:III
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 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:805-595-3231
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:805-595-3231
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64765207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
M124883OtherINTEGRATED HEALTH PLAN
1018OtherCMSP
ZZZ002934ZOtherBLUE SHIELD GROUP PIN
CA00A647650Medicaid
CACB239197OtherMEDICARE ID
6578092OtherAETNA PIN
ZZZ002934ZOtherBLUE SHIELD GROUP PIN
1018OtherCMSP