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General NPI Number Information
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NPI Number | 1225047012
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Entity Type | Individual
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Provider Name | PETER J MALOUF D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 7100 OAKMONT BLVD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76132-3908
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Country | US
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Telephone | 817-205-3075
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 OAKMONT BLVD STE 101
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City | FT WORTH
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State | TX
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Zip | 76132-3908
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Country | US
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Telephone | 817-205-3075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | K0518
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | K0518
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | K0518
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License Number State | TX
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