Individual
MR. BRUCE DOUGLAS MALLATT
Active
Individual
MR. BRUCE DOUGLAS MALLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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