Provider Demographics
NPI:1578794301
Name:KENNETH LESTER MALAMUD MD PLLC
Entity Type:Organization
Organization Name:KENNETH LESTER MALAMUD MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:MALAMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-715-3937
Mailing Address - Street 1:1001 BUCHANAN DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-2323
Mailing Address - Country:US
Mailing Address - Phone:512-715-3937
Mailing Address - Fax:512-715-3938
Practice Address - Street 1:1001 BUCHANAN DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2323
Practice Address - Country:US
Practice Address - Phone:512-715-3937
Practice Address - Fax:512-715-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1707207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG1707OtherLICENSE
TXG1707OtherLICENSE