Provider Demographics
NPI:1730285719
Name:MALASKY, BETH R (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:R
Last Name:MALASKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERTHA
Other - Middle Name:R
Other - Last Name:MALASKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3340 EAST GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-0000
Mailing Address - Fax:208-302-0055
Practice Address - Street 1:6140 CURTISIAN
Practice Address - Street 2:STE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0107
Practice Address - Country:US
Practice Address - Phone:208-302-0000
Practice Address - Fax:208-302-0055
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24046207RC0000X
IDM10921207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27826Medicare ID - Type Unspecified
AZ472019Medicaid
AZG13265Medicare UPIN