Provider Demographics
NPI:1396914883
Name:DAVID J MALLAMS,M.D.
Entity type:Organization
Organization Name:DAVID J MALLAMS,M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MALLAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-682-9869
Mailing Address - Street 1:2409 W ILLINOIS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6308
Mailing Address - Country:US
Mailing Address - Phone:432-682-9869
Mailing Address - Fax:432-684-3825
Practice Address - Street 1:2409 W ILLINOIS AVE STE C
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6308
Practice Address - Country:US
Practice Address - Phone:432-682-9869
Practice Address - Fax:432-684-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0299120001Medicare NSC