| Doctor Name: | MR. RICHARD D MALCOLM |
| NPI Number: | 1003981739 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | A.R.N.P. |
| License Number: | 2200082 |
| Business Practice Address: | 1218 Park Ave Orange Park, FL - 320734152 |
| Business Phone Number: | 9042692437 |
| Business Fax Number: | 9042642497 |
| Mailing Address: | 1218 Park Ave, ORANGE PARK |
| State: | FL |
| Postal Code: | 320734152 |
| Phone Number: | 9042692437 |
| Fax Number: | 9042642497 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 06/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2200082 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |