Provider Demographics
NPI: | 1972787927 |
---|---|
Name: | MALEK, FARBOD (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | FARBOD |
Middle Name: | |
Last Name: | MALEK |
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: | 2122 BABCOCK RD STE 101 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78229-4411 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-865-9200 |
Mailing Address - Fax: | 210-641-2805 |
Practice Address - Street 1: | 2122 BABCOCK RD |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78229-4411 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-865-9200 |
Practice Address - Fax: | 210-641-2805 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-12-27 |
Last Update Date: | 2022-10-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | N3853 | 207X00000X, 207XP3100X, 207XS0106X, 207XS0114X, 207XS0117X, 207XX0004X, 207XX0005X, 207XX0801X, 2081S0010X, 208200000X, 2082S0099X, 2082S0105X, 2086S0120X, 2086X0206X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | |
No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma |
No | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | |
No | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck |
No | 2082S0105X | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 327580202 | Medicaid | |
TX | 294278 | Medicare PIN |