Provider Demographics
NPI:1861610925
Name:MALCOM, TROY JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:JAMES
Last Name:MALCOM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1925 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3128
Mailing Address - Country:US
Mailing Address - Phone:720-718-8305
Mailing Address - Fax:303-485-3377
Practice Address - Street 1:1925 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3128
Practice Address - Country:US
Practice Address - Phone:720-718-8305
Practice Address - Fax:303-485-3377
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL998183208800000X
CODR.0045740208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07201222Medicaid
CO07201222Medicaid
COFM0309042OtherDEA