MEDICARE: DR. RON IAN MALCOLM ED.D.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1467882977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON IAN MALCOLM ED.D.

Provider Business Mailing Address
First Line	:	2532 N 107TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-3630
Country	:	US
Telephone Number	:	913-912-2714
Fax Number	:

Provider Business Practice Location Address
First Line	:	2532 N 107TH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-3630
Country	:	US
Telephone Number	:	913-306-6027
Fax Number	:	913-727-1602

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

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	02/05/2015

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