Mallatt, Bruce Douglas

Mallatt, Bruce Douglas is an sole proprietor health care provider with primary practice located at 700 Willow St Suite 203, Vincennes IN 47591-1028. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Mallatt, Bruce Douglas can be contacted via phone (812) 886-4572.

Contact Information

Primary practice address
700 Willow St Suite 203 Vincennes IN 47591-1028
Phone: (812) 886-4572
Fax: (812) 886-6571
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 01027539 Indiana
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X 01027539 Indiana
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 01027539 Indiana
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 01027539 Indiana

Profile Details

NPI number 1831173921
LBN Legal business name Mallatt, Bruce Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 1st, 2005
Last updated Jan 6th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831173921 NPPES
Indiana MEDICAID 100154760A

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