Provider Demographics
NPI:1821102062
Name:MALUBAY, RICHARD ALFRED (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALFRED
Last Name:MALUBAY
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 1:5607 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9313
Mailing Address - Country:US
Mailing Address - Phone:502-228-7444
Mailing Address - Fax:
Practice Address - Street 1:851 IRELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-2722
Practice Address - Country:US
Practice Address - Phone:502-624-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH64265Medicare UPIN