# MALLETT MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CHARLES MALLETT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053641134
- **Authorized official:** DR. CHARLES BAKER MALLETT III MD (OWNER/OFFICER)
- **Authorized official phone:** (512) 441-4400

## Contact information

- **Practice address:** 4007 JAMES CASEY ST, SUITE A-200, AUSTIN, TX 78745-3369
- **Practice address phone:** (512) 441-4400
- **Practice address fax:** (512) 441-7421
- **Mailing address:** 4007 JAMES CASEY ST, SUITE A-200, AUSTIN, TX 78745-3369
- **Mailing address phone:** (512) 441-4400
- **Mailing address fax:** (512) 441-7421

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | F1769 | TX | Yes |

## Other

- **Enumeration date:** 01/12/2010
- **Last updated:** 09/02/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | TXB111969 | MEDICARE PTAN | TX |