Provider Demographics
NPI:1285695700
Name:MALTER, JAMES SAMUEL (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SAMUEL
Last Name:MALTER
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 1:5323 HARRY HINES BLVD.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9072
Mailing Address - Country:US
Mailing Address - Phone:214-648-4020
Mailing Address - Fax:214-648-4067
Practice Address - Street 1:5323 HARRY HINES BLVD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9072
Practice Address - Country:US
Practice Address - Phone:214-648-4020
Practice Address - Fax:214-648-4067
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32781207ZB0001X, 207ZP0007X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004261Medicare UPIN