Basic Information
| Provider Information | |||||||||
| NPI: | 1164774923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SM MALOFF MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 HOSPITAL WAY STE 477 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832012744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082390380 | ||||||||
| FaxNumber: | 2082336983 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 VISTA DR | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832014987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082390380 | ||||||||
| FaxNumber: | 2082336983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2012 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | MALOFF | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2082390380 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2082S0105X | M 3508 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
No ID Information.