MEDICARE: MARY E MALCOM DO

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	207P00000X	Emergency Medicine Physician	3459	IA

General Provider Information

NPI Number	:	1417937699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E MALCOM DO

Provider Business Mailing Address
First Line	:	45 COLUMBIA ST
Second Line	:
City	:	CARLISLE
State	:	IA
Zip	:	50047-7715
Country	:	US
Telephone Number	:	515-989-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 COLUMBIA ST
Second Line	:
City	:	CARLISLE
State	:	IA
Zip	:	50047-7715
Country	:	US
Telephone Number	:	515-989-4143
Fax Number	:

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

Provider Enumeration Date	:	01/22/2006
Last Update Date	:	07/08/2007

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Directions to “ MARY E MALCOM DO” Practice Location

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