Provider Demographics
NPI:1154423689
Name:MALMQUIST, PETER GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:GEORGE
Last Name:MALMQUIST
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 1:2404 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2624
Mailing Address - Country:US
Mailing Address - Phone:864-225-0991
Mailing Address - Fax:864-225-5171
Practice Address - Street 1:2404 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2624
Practice Address - Country:US
Practice Address - Phone:864-225-0991
Practice Address - Fax:864-225-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC126633Medicaid
SCB92448Medicare UPIN