1518943356 NPI number — DR. SHARON A MALONE M.D.

Table of content: DR. SHARON A MALONE M.D. (NPI 1518943356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518943356 NPI number — DR. SHARON A MALONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MALONE
Provider First Name:
SHARON
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518943356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 N HIGHLAND AVE
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75092-5631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-814-4911
Provider Business Mailing Address Fax Number:
866-542-0691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-5631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-814-4911
Provider Business Practice Location Address Fax Number:
866-542-0691
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K6119 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 930072623 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 89932K . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 102521508 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102521501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8U4002 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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