Organization Name: | SUBODH K MALLIK MD PA |
NPI Number: | 1477847234 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUBODH MALLIK (DR./OWNER) |
Mailing Address: | 2071 N Main St Fort Stockton |
State: | TX US |
Postal Code: | 797353041 |
Phone Number: | 4323360700 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2011 |
NPI Last Update Date: | 06/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |