Provider Demographics
NPI:1598027880
Name:ERNESTO MALAVE MD PA
Entity Type:Organization
Organization Name:ERNESTO MALAVE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-432-5735
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2301 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4143
Practice Address - Country:US
Practice Address - Phone:254-432-5735
Practice Address - Fax:254-432-5737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty