Healthcare Provider Details
I. General information
NPI: 1285676767
Provider Name (Legal Business Name): TOREE H MALASANOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/11/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1600 SW ARCHER ROAD BOX 100371
GAINESVILLE FL
32610-3003
US
IV. Provider business mailing address
PO BOX 918025
ORLANDO FL
32891-8025
US
V. Phone/Fax
- Phone: 352-334-1390
- Fax: 352-334-1325
- Phone: 352-334-1390
- Fax: 352-334-1325
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2080P0205X |
| Taxonomy | Pediatric Endocrinology Physician |
| License Number | ME66773 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: