Provider Demographics
NPI:1932149408
Name:MALONE, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:MALONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 54
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:918-794-5542
Mailing Address - Fax:918-794-5548
Practice Address - Street 1:1919 S WHEELING AVE
Practice Address - Street 2:STE # 706
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5638
Practice Address - Country:US
Practice Address - Phone:918-794-5543
Practice Address - Fax:918-794-5548
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-09-02
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Provider Licenses
StateLicense IDTaxonomies
OK19416207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100195150AMedicaid
OK100195150AMedicaid
OKF88750Medicare UPIN