Individual
IAN GRANT MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AK 35255-5310
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
8704
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124237
—
MS
01
—
16-00152
UNITED HEALTHCARE
AL
01
—
51504313
BCBS
AL
01
—
51533244
BCBS
AL
Enumeration date
05/20/2006
Last updated
07/08/2007
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