Provider Demographics
NPI:1609985852
Name:MALAVE, ERNESTO (MD)
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:MALAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540-0938
Mailing Address - Country:US
Mailing Address - Phone:254-634-6999
Mailing Address - Fax:254-200-4099
Practice Address - Street 1:2301 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 108
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4119
Practice Address - Country:US
Practice Address - Phone:254-432-5735
Practice Address - Fax:254-432-5737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ7063OtherSTATE LICENSE
TXX0125187OtherDPS REGISTRATION NUMBER
TX00N96LOtherBCBS PROVIDER
TX00N96LOtherBCBS PROVIDER
TX614254Medicare PIN
TXD18070Medicare UPIN