Provider Demographics
NPI:1780651471
Name:MALAMUD, FERNANDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:C
Last Name:MALAMUD
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:PO BOX 15115
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5115
Mailing Address - Country:US
Mailing Address - Phone:850-784-9977
Mailing Address - Fax:
Practice Address - Street 1:2202 STATE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7601
Practice Address - Country:US
Practice Address - Phone:850-784-9977
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76858207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44726OtherBCBS FL
FLG81880Medicare UPIN
FLE1375AMedicare ID - Type Unspecified