Provider Demographics
NPI:1912997909
Name:MALAVE, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MALAVE
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 1:14615 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4316
Mailing Address - Country:US
Mailing Address - Phone:210-495-4200
Mailing Address - Fax:210-495-4203
Practice Address - Street 1:14615 SAN PEDRO AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4316
Practice Address - Country:US
Practice Address - Phone:210-495-4200
Practice Address - Fax:210-495-4203
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2440208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1846990Medicaid
I60412Medicare UPIN