Provider Demographics
NPI:1487639365
Name:MALMAY, KIM RAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:RAMON
Last Name:MALMAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5237
Mailing Address - Country:US
Mailing Address - Phone:318-322-3025
Mailing Address - Fax:318-966-7709
Practice Address - Street 1:205 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5237
Practice Address - Country:US
Practice Address - Phone:318-322-3025
Practice Address - Fax:318-966-7709
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA016648OtherMEDICAL LICENSE
LA1352420Medicaid
AM1822786OtherDEA LICENSE
E25238Medicare UPIN