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Organization
MALLETT MD, PA
Active
Organization
MALLETT MD, PA
Active
Other names
CHARLES MALLETT
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES BAKER MALLETT III MD (OWNER/OFFICER)
(512) 441-4400
Entity
Organization
Contact information
Practice address
4007 JAMES CASEY ST, SUITE A-200, AUSTIN, TX 78745-3369
(512) 441-4400
(512) 441-7421
Mailing address
4007 JAMES CASEY ST, SUITE A-200, AUSTIN, TX 78745-3369
(512) 441-4400
(512) 441-7421
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F1769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB111969
MEDICARE PTAN
TX
Enumeration date
01/12/2010
Last updated
09/02/2011
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