Provider Demographics
NPI:1740210798
Name:MALZ, MARTIN A (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:MALZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 PIPER BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1387
Mailing Address - Country:US
Mailing Address - Phone:239-500-9080
Mailing Address - Fax:239-500-9070
Practice Address - Street 1:1205 PIPER BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1387
Practice Address - Country:US
Practice Address - Phone:239-500-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040653L207R00000X
FLME129765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA432494Medicare PIN