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Individual
JENNIFER KATHLEEN MALCOLM
Active
Individual
JENNIFER KATHLEEN MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
02003812A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
05-37550
KS
Other
Enumeration date
06/25/2008
Last updated
09/05/2014
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