Provider Demographics
NPI:1588746556
Name:MALICK, JEWELL E (DO)
Entity type:Individual
Prefix:
First Name:JEWELL
Middle Name:E
Last Name:MALICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RELIANCE CT
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-8415
Mailing Address - Country:US
Mailing Address - Phone:469-698-0118
Mailing Address - Fax:
Practice Address - Street 1:901 ROCKWALL PKWY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6502
Practice Address - Country:US
Practice Address - Phone:972-772-3234
Practice Address - Fax:972-772-3834
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00T30WMedicare ID - Type Unspecified
TXB18604Medicare UPIN