Individual
ASHOK R MALLYA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
12515 WINDMOOR PL, SAINT LOUIS, MO 63131-3019
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
R6991
MO
Other
Enumeration date
05/27/2006
Last updated
07/08/2007
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