Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | A64765 | CA |
NPI | 1457343113 |
---|---|
Provider Name | Dr. James M Malone III |
First Address | Santa Maria, CA 93458-2805 |
Second Address | San Luis Obispo, CA 93401-7068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 26/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A647650 | (05) | CA |
1018 | CMSP (01) | |
6578092 | AETNA PIN (01) | |
CB239197 | MEDICARE ID (01) | CA |
M124883 | INTEGRATED HEALTH PLAN (01) | |
ZZZ002934Z | BLUE SHIELD GROUP PIN (01) |