Provider Demographics
NPI:1740215284
Name:MAJOR, MALCOLM MARVIN (MD)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:MARVIN
Last Name:MAJOR
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 1:301 NW 84TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1807
Mailing Address - Country:US
Mailing Address - Phone:954-474-3010
Mailing Address - Fax:954-474-2129
Practice Address - Street 1:301 NW 84TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1807
Practice Address - Country:US
Practice Address - Phone:954-474-3010
Practice Address - Fax:954-474-2129
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55747207RH0002X
FLME0055747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271966500Medicaid
FL09798WMedicare ID - Type Unspecified
FL271966500Medicaid