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General NPI Number Information
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NPI Number | 1861489106
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Entity Type | Individual
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Provider Name | MATTHEW MICAH MALAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 1314 E SONTERRA BLVD STE 2201
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4287
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Country | US
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Telephone | 210-496-5792
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Fax | 210-496-7601
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Provider Business Mailing Address
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Address Line | 1314 E SONTERRA BLVD STE 2201
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4287
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Country | US
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Telephone | 210-496-5792
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M-8852
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 67944
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License Number State | AZ
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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 | A116923
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 13011731-1205
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License Number State | UT
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | U0395
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License Number State | TX
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