MEDICARE: DR. WILLIAM G MALCOLM DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO2054	FL

General Provider Information

NPI Number	:	1366428492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM G MALCOLM DPM

Provider Business Mailing Address
First Line	:	4900 SW 101ST AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3307
Country	:	US
Telephone Number	:	954-804-2232
Fax Number	:	305-865-0844

Provider Business Practice Location Address
First Line	:	4900 SW 101ST AVE
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33328-3307
Country	:	US
Telephone Number	:	305-866-0268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	09/27/2023

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