Malone, Dwight M

Malone, Dwight M is an individual health care provider with primary practice located at 1505 N Country Club Dr Apt 118 , Mesa AZ 85201-2518. He recently has only one registered license in Other Service Providers / Driver, which is considered as his primary health care specialty. Malone, Dwight M can be contacted via phone (480) 547-4960.

Contact Information

Primary practice address
1505 N Country Club Dr Apt 118 Mesa AZ 85201-2518
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Driver 172A00000X L2088992 Arizona

Profile Details

NPI number 1154774107
LBN Legal business name Malone, Dwight M
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2016
Last updated Jul 14th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154774107 NPPES
Arizona MEDICAID 812493202

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