Provider Demographics
NPI:1952404253
Name:MALONE, J. DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:J. DAVID
Middle Name:
Last Name:MALONE
Suffix:
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 1:909 HYDE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4845
Mailing Address - Country:US
Mailing Address - Phone:415-292-3313
Mailing Address - Fax:415-563-5561
Practice Address - Street 1:909 HYDE STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4845
Practice Address - Country:US
Practice Address - Phone:415-292-3313
Practice Address - Fax:415-415-5635
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43355207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C433550Medicaid
CA00C433550Medicaid
E86039Medicare UPIN