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NPI Code Detail

MEDICARE: ROGER SCOTT MALM PA

MEDICARE: ROGER SCOTT MALM PA
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
1363A00000XPhysician AssistantPA220ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA-220OTHERIDSTATE LICENSE

General Provider Information

NPI Number : 1730190935
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER SCOTT MALM PA
Provider Business Mailing Address
First Line : 824 S DIAMOND ST
Second Line :
City : NAMPA
State : ID
Zip : 83686-5960
Country : US
Telephone Number : 208-606-0396
Fax Number : 208-936-7002
Provider Business Practice Location Address
First Line : 824 S DIAMOND ST
Second Line :
City : NAMPA
State : ID
Zip : 83686-5960
Country : US
Telephone Number : 208-606-0396
Fax Number : 208-936-7002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 12/17/2024

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Directions to “ ROGER SCOTT MALM PA” Practice Location

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