Individual
DR. WILLIAM J. MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2941 S RIDGE RD, GREEN BAY, WI 54304-5517
(920) 336-4096
(920) 336-8093
Mailing address
2941 S RIDGE RD, GREEN BAY, WI 54304-5517
(920) 336-4096
(920) 336-8093
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22719-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31370200
—
WI
Enumeration date
07/14/2006
Last updated
06/02/2008
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