Provider Demographics
NPI:1558447300
Name:JOHN G MALOUF DO PA
Entity Type:Organization
Organization Name:JOHN G MALOUF DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-985-2015
Mailing Address - Street 1:5022 HOLLY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4761
Mailing Address - Country:US
Mailing Address - Phone:361-985-2015
Mailing Address - Fax:361-985-2016
Practice Address - Street 1:5022 HOLLY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4761
Practice Address - Country:US
Practice Address - Phone:361-985-2015
Practice Address - Fax:361-985-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3387207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152280703Medicaid
TX00047ZOtherMEDICARE GROUP ID
TX152280703Medicaid
TX00047ZOtherMEDICARE GROUP ID