Organization
VINCENT D. MALLORY MD., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE FISHER MALLORY (OFFICE MANGER)
(318) 487-1717
Entity
Organization
Contact information
Practice address
3311 PRESCOTT RD, SUITE 316, ALEXANDRIA, LA 71301-3900
(318) 487-1717
(318) 487-1170
Mailing address
3311 PRESCOTT RD, SUITE 316, ALEXANDRIA, LA 71301-3900
(318) 487-1717
(318) 487-1170
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215918503
NPI-INDIVIDUAL
LA
05
—
1574520
—
LA
Enumeration date
03/08/2012
Last updated
03/08/2012
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