Provider Demographics
NPI:1699785592
Name:MALPHURS, ROY A (PA)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:MALPHURS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 N GALLOWAY AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2461
Mailing Address - Country:US
Mailing Address - Phone:972-216-4900
Mailing Address - Fax:972-216-4903
Practice Address - Street 1:1320 N GALLOWAY AVE STE 104
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2461
Practice Address - Country:US
Practice Address - Phone:972-216-4900
Practice Address - Fax:972-216-4903
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N8623OtherBCBS OF TEXAS
TX8N9708OtherBCBS OF TEXAS
TX8N9708OtherBCBS OF TEXAS
TX8D9464Medicare ID - Type Unspecified
TX8N8623OtherBCBS OF TEXAS