Individual
ROGER SCOTT MALM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
824 S DIAMOND ST, NAMPA, ID 83686-5960
(208) 606-0396
(208) 936-7002
Mailing address
824 S DIAMOND ST, NAMPA, ID 83686-5960
(208) 606-0396
(208) 936-7002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA220
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-220
STATE LICENSE
ID
Enumeration date
08/11/2006
Last updated
12/17/2024
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