Healthcare Provider Details

I. General information

NPI: 1124472055
Provider Name (Legal Business Name): STUART MALCOLM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2261 MARKET ST # 10535
SAN FRANCISCO CA
94114-1612
US

IV. Provider business mailing address

2261 MARKET ST # 10535
SAN FRANCISCO CA
94114-1612
US

V. Phone/Fax

Practice location:
  • Phone: 408-508-4163
  • Fax: 888-789-1402
Mailing address:
  • Phone: 408-508-4163
  • Fax: 888-789-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA159926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: