Individual
DR. VINCENT D MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 466-2106
Mailing address
2495 SHREVEPORT HWY, PINEVILLE, LA 71360-4044
(318) 466-2106
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015979
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1574520
—
LA
Enumeration date
11/14/2005
Last updated
10/24/2023
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