Individual
MR. LARRY GENE MALCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9040 REID ST, MCHJ-QCR, TACOMA, WA 98431-1100
(253) 968-2252
(253) 968-3278
Mailing address
6640 198TH AVE SW, ROCHESTER, WA 98579-9392
(360) 539-5930
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10002342
WA
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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