Individual
CARL S. MALMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5201 HARRY HINES BLVD, AMBULATORY CARE CLINIC, DALLAS, TX 75235-7708
(214) 590-5512
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00019
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180359501
—
TX
05
—
180359502
—
TX
01
—
8N4400
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/07/2005
Last updated
10/13/2008
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