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Individual

MR. MALLORY T HARLING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1450 E VALLEY RD STE 105, BASALT, CO 81621-8352
(970) 927-1717
(970) 927-6164
Mailing address
1450 E VALLEY RD STE 105, BASALT, CO 81621-8352
(970) 927-1717
(970) 927-6164

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
16141
CO
207VG0400X
Gynecology Physician
16141
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01161413
CO
01
1609842145
GROUP NPI
01
201467647
TAX ID
Enumeration date
02/24/2006
Last updated
03/06/2008
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