Individual
DWIGHT M MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1505 N COUNTRY CLUB DR APT 118, MESA, AZ 85201-2518
(480) 547-4960
Mailing address
1505 N COUNTRY CLUB DR APT 118, MESA, AZ 85201-2518
(480) 547-4960
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
L2088992
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
812493202
—
AZ
Enumeration date
07/14/2016
Last updated
07/14/2016
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