MEDICARE: MALOUF DERMATOLOGY DALLAS 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	207N00000X	Dermatology Physician	K0518	TX

General Provider Information

NPI Number	:	1326207945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALOUF DERMATOLOGY DALLAS PA

Provider Business Mailing Address
First Line	:	6115 BERKSHIRE LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6115 BERKSHIRE LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-5537
Country	:	US
Telephone Number	:	817-489-6908
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER J MALOUF
Credential	:	MD
Telephone Number	:	817-489-6908

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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