Mr. Bruce Douglas Mallatt
Dermatologist Dermatopathologist Procedural Dermatology MOHS-Micrographic Surgeon
700 Willow St Suite 203
Vincennes
, Indiana 47591-1028
Mr. Bruce Douglas Mallatt
Dermatologist Dermatopathologist Procedural Dermatology MOHS-Micrographic Surgeon
700 Willow St Suite 203
Vincennes
, Indiana 47591-1028
(812) 886-6571
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
- Dermatopathologist
- Procedural Dermatology
Languages spoken
- English
Location
First Address
- Mr. Bruce Douglas Mallatt
- 700 Willow St Suite 203
- Vincennes, IN
- Zip : 47591-1028
- Fax : (812) 886-6571
- Phone : (812) 886-4572
Second Address
- Mr. Bruce Douglas Mallatt
- 700 Willow St Suite 203
- Vincennes, IN
- Zip : 47591-1028
- Fax : (812) 886-6571
- Phone : (812) 886-4572
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Is Mr. Bruce Douglas Mallatt a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 01027539 | IN |
| N | 207ND0101X | MOHS-Micrographic Surgeon | 01027539 | IN |
| N | 207ND0900X | Dermatopathologist | 01027539 | IN |
| N | 207NS0135X | Procedural Dermatology | 01027539 | IN |
National Provider Identifier
| NPI | 1831173921 |
|---|---|
| Provider Name | Mr. Bruce Douglas Mallatt |
| First Address | Vincennes, IN 47591-1028 |
| Second Address | Vincennes, IN 47591-1028 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/12/2005 |
| Last Update Date | 06/01/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 100154760A | (05) | IN |
| A01460 | (02) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.