Provider Demographics
NPI:1316997984
Name:MALIN, JENNIFER KENT (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KENT
Last Name:MALIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4212 W CONGRESS ST STE 2300A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6778
Mailing Address - Country:US
Mailing Address - Phone:337-237-7801
Mailing Address - Fax:337-235-1865
Practice Address - Street 1:4212 W CONGRESS ST STE 2300A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6778
Practice Address - Country:US
Practice Address - Phone:337-237-7801
Practice Address - Fax:337-235-1865
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019335207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1968633Medicaid
LA5R5907506Medicare ID - Type Unspecified
LA1968633Medicaid