Provider Demographics
NPI:1437187192
Name:FERNANDO C MALAMUD MD PA
Entity Type:Organization
Organization Name:FERNANDO C MALAMUD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-784-9977
Mailing Address - Street 1:PO BOX 15115
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5115
Mailing Address - Country:US
Mailing Address - Phone:850-784-9977
Mailing Address - Fax:850-784-9980
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-784-9977
Practice Address - Fax:850-784-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76858207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG81880Medicare UPIN