# MR. MICHAEL DEAN MALLON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1194121715
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | OR | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | PA218438 | OR | Yes |

## Other

- **Enumeration date:** 11/10/2014
- **Last updated:** 07/10/2024