Provider Demographics
NPI:1093346421
Name:MALBEC, IAN WILLIAM
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:WILLIAM
Last Name:MALBEC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 S RIVERSIDE DR APT 302
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-5619
Mailing Address - Country:US
Mailing Address - Phone:954-703-0516
Mailing Address - Fax:
Practice Address - Street 1:629 S RIVERSIDE DR APT 302
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5619
Practice Address - Country:US
Practice Address - Phone:954-703-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer