Provider Demographics
NPI:1396853610
Name:MALFESE, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:MALFESE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2880 FOLSOM STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:720-737-6497
Mailing Address - Fax:978-620-2346
Practice Address - Street 1:2880 FOLSOM STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:720-737-6497
Practice Address - Fax:978-620-2346
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2014-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI41373207Q00000X
CODR0053194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34091900Medicaid
WI095472200Medicare ID - Type Unspecified
H37738Medicare UPIN