Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 309109 | LA |
NPI | 1043655434 |
---|---|
Provider Name | Charles Brandon Maloy |
First Address | Clyde, NC 28721-8085 |
Second Address | New Orleans, LA 70121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 07/09/2021 |