Larry Gene Malcolm, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10002342 Issued in WA

Practice address

9040 Reid St
MCHJ-QCR
Tacoma, WA 98431-1100

Phone

(253) 968-2252

Fax

(253) 968-3278

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952525248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 198TH AVE SW",
            "city": "ROCHESTER",
            "state": "WA",
            "postal_code": "985799392",
            "telephone_number": "360-539-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 REID ST",
            "address_2": "MCHJ-QCR",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984311100",
            "telephone_number": "253-968-2252",
            "fax_number": "253-968-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALCOLM",
        "first_name": "LARRY",
        "middle_name": "GENE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10002342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Douglas Makoviney
• Nicole Alecia Makula, DNP, ARNP, CPNP-AC
• Jordana Susanne Malace, RN, BSN
• Evangline Malagon-Duran, LMFT
• Aidan Malalang, DPT
• Elizabeth Marie Maldonado, BSN RN
• Vinay Malhotra, MD
• Rabia Khalid Malik, DO
• Jessica Malley, PHD
• Sean Aaron Mallon, D.O

• Physician Assistant in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.