Bruce Douglas Mallatt, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01027539 Issued in IN

Practice address

700 Willow St
Suite 203
Vincennes, IN 47591-1028

Phone

(812) 886-4572

Fax

(812) 886-6571

NPI assigned

Dec 1, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262736000000",
    "number": "1831173921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 WILLOW ST",
            "address_2": "SUITE 203",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911028",
            "telephone_number": "812-886-4572",
            "fax_number": "812-886-6571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WILLOW ST",
            "address_2": "SUITE 203",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475911028",
            "telephone_number": "812-886-4572",
            "fax_number": "812-886-6571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLATT",
        "first_name": "BRUCE",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2010-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01027539",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IN",
            "license": "01027539",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IN",
            "license": "01027539",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "IN",
            "license": "01027539",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100154760A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Garry Bernard Malnar, D.O.
• Jason Andrew Mancini, MSN, CRNA
• Steven C Marchino, MD
• Morgan Marczak, LCSW
• Veronica Sara Mark, MD

• Dermatology Physician in Vincennes, IN
• Providers in Vincennes, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.