Individual
DAVID W MALY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2904 NORTH 4TH STREET, LRMC, LONGVIEW, TX 75605
(903) 232-3725
Mailing address
204 WOODBINE PL, WHITE OAK, TX 75693-3907
(903) 291-0011
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
513830
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002538904
—
TX
05
—
002538908
—
TX
01
—
75-0818167-015
TRICARE
TX
01
—
P01536081
RAIL ROAD
TX
Enumeration date
06/16/2005
Last updated
12/07/2015
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