Provider Demographics
NPI:1033126271
Name:MALAN, LEE JEPPSON (MD)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:JEPPSON
Last Name:MALAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3955 HARRISON BLVD
Mailing Address - Street 2:SUITE U1
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-621-3591
Mailing Address - Fax:801-393-0836
Practice Address - Street 1:3955 HARRISON BLVD
Practice Address - Street 2:SUITE U1
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-621-3591
Practice Address - Fax:801-393-0836
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15652912052086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D07265Medicare UPIN