Provider Demographics
NPI:1659372837
Name:MALOUF, JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MALOUF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5022 HOLLY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-985-2015
Mailing Address - Fax:
Practice Address - Street 1:5022 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4736
Practice Address - Country:US
Practice Address - Phone:361-985-2015
Practice Address - Fax:361-985-2016
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3387207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152280703Medicaid
TX152280703Medicaid
TX00250FMedicare ID - Type UnspecifiedPERSONAL MEDICARE NUMBER