Individual
GREGORY WAYNE MALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
425 W JACKSON ST, PIGGOTT, AR 72454-1538
(870) 598-2236
(870) 598-3080
Mailing address
140 STONERIDGE DR S STE 100, RUCKERSVILLE, VA 22968-3096
(434) 654-1850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101265974
VA
207Q00000X
Family Medicine Physician
E2399
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140508001
—
AR
Enumeration date
08/03/2006
Last updated
01/16/2024
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