Provider Demographics
NPI:1912081662
Name:JIM MALONE DPM A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:JIM MALONE DPM A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:661-832-6300
Mailing Address - Street 1:4000 STOCKDALE HWY STE C
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2059
Mailing Address - Country:US
Mailing Address - Phone:661-832-3600
Mailing Address - Fax:661-831-0784
Practice Address - Street 1:4000 STOCKDALE HWY STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2059
Practice Address - Country:US
Practice Address - Phone:661-832-3600
Practice Address - Fax:661-831-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2282213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11257Medicare UPIN