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General NPI Number Information
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NPI Number | 1649242538
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Entity Type | Individual
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Provider Name | DAVID JOEL MALIS MD
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 1499 S HARBOR CITY BLVD SUITE 303
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City | MELBOURNE
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State | FL
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Zip | 32901-3245
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Country | US
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Telephone | 321-254-5437
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Fax | 321-254-4543
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Provider Business Mailing Address
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Address Line | 1499 S HARBOR CITY BLVD SUITE 303
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City | MELBOURNE
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State | FL
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Zip | 32901-3245
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Country | US
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Telephone | 321-254-5437
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Fax | 321-254-4543
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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 | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | ME90348
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | ME90348
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License Number State | FL
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