MEDICARE: MALVIN COLEMAN DRIVER JR. M.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	207W00000X	Ophthalmology Physician	E7897	TX
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	E7897	TX
3	207WX0108X	Uveitis and Ocular Inflammatory Disease (Ophthalmology) Physician	E7897	TX
4	207WX0107X	Retina Specialist (Ophthalmology) Physician	52609	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609800127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALVIN COLEMAN DRIVER JR. M.D.

Provider Business Mailing Address
First Line	:	2191 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1836
Country	:	US
Telephone Number	:	210-348-8788
Fax Number	:	210-348-8768

Provider Business Practice Location Address
First Line	:	2191 NW MILITARY HWY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1836
Country	:	US
Telephone Number	:	210-348-8788
Fax Number	:	210-348-8768

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/05/2019

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Directions to “ MALVIN COLEMAN DRIVER JR. M.D.” Practice Location

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