Individual
MR. BRUCE DOUGLAS MALLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
700 WILLOW ST, SUITE 203, VINCENNES, IN 47591-1028
(812) 886-4572
(812) 886-6571
Mailing address
700 WILLOW ST, SUITE 203, VINCENNES, IN 47591-1028
(812) 886-4572
(812) 886-6571
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01027539
IN
207ND0101X
MOHS-Micrographic Surgery Physician
01027539
IN
207ND0900X
Dermatopathology Physician
01027539
IN
207NS0135X
Procedural Dermatology Physician
01027539
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100154760A
—
IN
Enumeration date
12/01/2005
Last updated
01/06/2010
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