Healthcare Provider Details

I. General information

NPI: 1366428492
Provider Name (Legal Business Name): WILLIAM G MALCOLM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SW 101ST AVE
COOPER CITY FL
33328-3307
US

IV. Provider business mailing address

4900 SW 101ST AVE
COOPER CITY FL
33328-3307
US

V. Phone/Fax

Practice location:
  • Phone: 305-866-0268
  • Fax:
Mailing address:
  • Phone: 954-804-2232
  • Fax: 305-865-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: