Provider Demographics
NPI:1801891270
Name:MACLAREN, MALCOLM C (DO)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:C
Last Name:MACLAREN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18133 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2214
Mailing Address - Country:US
Mailing Address - Phone:813-496-1075
Mailing Address - Fax:813-249-7762
Practice Address - Street 1:18133 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2214
Practice Address - Country:US
Practice Address - Phone:813-496-1075
Practice Address - Fax:813-249-7762
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8857207X00000X, 207XX0005X, 207XX0801X, 207XS0114X, 207XX0004X, 207XS0106X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78820XMedicare PIN