MEDICARE: JOHN E MALLEY 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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO1806	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87971	OTHER	FL	BCBS ID

General Provider Information

NPI Number	:	1982608451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E MALLEY DPM

Provider Business Mailing Address
First Line	:	2664 SW IMMANUEL DR.
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2738
Country	:	US
Telephone Number	:	772-288-3338
Fax Number	:	772-288-3341

Provider Business Practice Location Address
First Line	:	2664 SW IMMANUEL DR.
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2738
Country	:	US
Telephone Number	:	772-288-3338
Fax Number	:	772-288-3341

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/09/2007

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Directions to “ JOHN E MALLEY DPM” Practice Location

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