Mr Bruce Douglas Mallatt, MD is a
Dermatology physician based in Vincennes, Indiana. Mr Bruce Douglas Mallatt is licensed to practice in Indiana (license number 01027539) and his current practice location is 700 Willow St, Suite 203, Vincennes, Indiana. He can be reached at his office (for appointments etc.) via phone at
(812) 886-4572.
NPI number for Mr Bruce Douglas Mallatt is 1831173921 and his current mailing address is 700 Willow St, Suite 203, Vincennes, Indiana. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1831173921.
Physician's Profile
| Full Name | Mr Bruce Douglas Mallatt |
|---|
| Gender | Male |
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| Speciality | Dermatology |
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| Location | 700 Willow St, Vincennes, Indiana |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1831173921
- Provider Enumeration Date: 12/01/2005
- Last Update Date: 01/06/2010
Medical Identifiers
Medical identifiers for Mr Bruce Douglas Mallatt such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1831173921 | NPI | - | NPPES |
| 100154760A | Medicaid | IN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207N00000X | Dermatology | 01027539 (Indiana) | Primary |
| 207NS0135X | Dermatology - Procedural Dermatology | 01027539 (Indiana) | Secondary |
| 207ND0101X | Dermatology - Mohs-micrographic Surgery | 01027539 (Indiana) | Secondary |
| 207ND0900X | Dermatology - Dermatopathology | 01027539 (Indiana) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Bruce Douglas Mallatt is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Bruce Douglas Mallatt, MD
700 Willow St, Suite 203,
Vincennes, IN 47591-1028
Ph: (812) 886-4572 | Mr Bruce Douglas Mallatt, MD
700 Willow St, Suite 203,
Vincennes, IN 47591-1028
Ph: (812) 886-4572 |
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