Doctor Name: | DR. TAYMOUR EDWARD MALAK |
NPI Number: | 1104931260 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A400760 |
Business Practice Address: | 2800 N California St Ste 11 2800 N. California Street Suite 11 Stockton, CA - 952043758 |
Business Phone Number: | 2094655891 |
Business Fax Number: | 2094650008 |
Mailing Address: | 2800 N California St Ste 11, 2800 N. California Street Suite 11 STOCKTON |
State: | CA |
Postal Code: | 952043758 |
Phone Number: | 2094655891 |
Fax Number: | 2094650008 |
NPI Enumeration Date: | 08/20/2006 |
NPI Last Update Date: | 02/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A400760 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |