Doctor Name: | MR. BENJAMIN DANIEL MALCOLM |
NPI Number: | 1013083229 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | COA.15883-NP |
Business Practice Address: | 3165 Dayton Xenia Rd Dayton, OH - 454346309 |
Business Phone Number: | 9379120525 |
Business Fax Number: | |
Mailing Address: | 2620 Elm Hill Pike, NASHVILLE |
State: | TN |
Postal Code: | 372143108 |
Phone Number: | 6154254287 |
Fax Number: | |
NPI Enumeration Date: | 11/28/2006 |
NPI Last Update Date: | 08/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | COA.15883-NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |