Individual
DR. TERESA DEAN MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13995 W STATLER BLVD, SURPRISE, AZ 85374-5501
(623) 478-3100
Mailing address
13995 W STATLER BLVD, SURPRISE, AZ 85374-5501
(623) 478-3100
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
40361
AZ
207V00000X
Obstetrics & Gynecology Physician
81716
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81716
TRAINING PERMIT
AZ
Enumeration date
04/18/2008
Last updated
11/12/2015
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