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General NPI Number Information
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NPI Number | 1295876969
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Entity Type | Individual
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Provider Name | GUEORGUI T MALTCHEV PA
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 316 ALYSE RD
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City | ROANOKE
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State | TX
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Zip | 76262-6158
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Provider Business Mailing Address
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Address Line | 3905 MELCER DR STE 601
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City | ROWLETT
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State | TX
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Zip | 75088-4033
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA05108
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License Number State | TX
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