Healthcare Provider Details

I. General information

NPI: 1730040874
Provider Name (Legal Business Name): DOUGLAS ALLAN MALIN SOIDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D RECONNAISSANCE BATTALION 3D MARINE DIVISION, FMF OPC 563 BOX 58
FPO AP
96388-9001
US

IV. Provider business mailing address

CAMP SCHWAB, OKINAWA, JAPAN 3D RECON BN UPR 36180 BOX 368
FPO AP
96388-8003
US

V. Phone/Fax

Practice location:
  • Phone: 912-276-3068
  • Fax:
Mailing address:
  • Phone: 912-276-3068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: