Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 323139 | LA |
NPI | 1114303443 |
---|---|
Provider Name | Christopher Malone |
First Address | Springfield, OH 45503-1114 |
Second Address | Springfield, OH 45503-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2015 |
Last Update Date | 12/07/2021 |