MEDICARE: WILLIAM G MALCOLM DPM PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO2054	FL

General Provider Information

NPI Number	:	1093867145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM G MALCOLM DPM PA

Provider Business Mailing Address
First Line	:	4900 SW 101ST AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3307
Country	:	US
Telephone Number	:	305-866-0268
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 SW 101ST AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3307
Country	:	US
Telephone Number	:	305-866-0268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM MALCOLM
Credential	:	DPM
Telephone Number	:	305-866-0268

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	09/27/2023

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