Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 034412 | GA |
NPI | 1497726814 |
---|---|
Provider Name | Dr. Randolph Augustus Malone IV |
First Address | Tallahassee, FL 32308-1550 |
Second Address | Tallahassee, FL 32308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000465671A | (05) | GA |
E62149 | (02) | GA |