Healthcare Provider Details

I. General information

NPI: 1336768266
Provider Name (Legal Business Name): RYAN ALEXXANDER MALAVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

660 SOUTH EUCLID AVE CAMPUS BOX 8111
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code2084N0400X
TaxonomyNeurology Physician
License Number2025012285
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: