Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO780 | FL |
NPI | 1609878495 |
---|---|
Provider Name | Dr. Stephen Malin |
First Address | West Palm Beach, FL 33417-4624 |
Second Address | West Palm Beach, FL 33417-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 10/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041082900 | (05) | FL |
87509Y | (02) | FL |
T55443 | (02) | FL |