Provider Demographics
NPI:1790034361
Name:MALIN, LAMAR KELTON (MD)
Entity type:Individual
Prefix:
First Name:LAMAR
Middle Name:KELTON
Last Name:MALIN
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 1:14818 FIR KNOLL WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5853
Mailing Address - Country:US
Mailing Address - Phone:281-256-2079
Mailing Address - Fax:
Practice Address - Street 1:14818 FIR KNOLL WAY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5853
Practice Address - Country:US
Practice Address - Phone:281-256-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8560207Q00000X
MDD24041207Q00000X
LA05010R207Q00000X
DC17256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine