Provider Demographics
NPI:1376536045
Name:MALAIN, JOHN M (DPM, PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:MALAIN
Suffix:
Gender:M
Credentials:DPM, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 FANNIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3804
Mailing Address - Country:US
Mailing Address - Phone:409-832-8800
Mailing Address - Fax:409-832-6426
Practice Address - Street 1:3480 FANNIN ST
Practice Address - Street 2:STE D
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3804
Practice Address - Country:US
Practice Address - Phone:409-832-8800
Practice Address - Fax:409-832-6426
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1142213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127207201Medicaid
TX00K23HMedicare ID - Type Unspecified
TX127207201Medicaid