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Individual
THOMAS G. MALLOY
Active
Individual
THOMAS G. MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
107458
MN
207RG0100X
Gastroenterology Physician
31007
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31598000
—
WI
01
—
P00700736
RR MEDICARE
WI
Enumeration date
04/05/2006
Last updated
05/06/2014
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