Provider Demographics
NPI:1861489106
Name:MALAN, MATTHEW MICAH (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:MICAH
Last Name:MALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1314 E SONTERRA BLVD STE 2201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4287
Mailing Address - Country:US
Mailing Address - Phone:210-496-5792
Mailing Address - Fax:
Practice Address - Street 1:1314 E SONTERRA BLVD STE 2201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4287
Practice Address - Country:US
Practice Address - Phone:210-496-5792
Practice Address - Fax:210-496-7601
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8852207N00000X
AZ67944207N00000X
CAA116923207N00000X
UT13011731-1205207N00000X
TXU0395207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN