Individual
HARVEY E MALLORY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7000 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-4313
(505) 344-9478
(505) 344-2783
Mailing address
PO BOX 95590, ALBUQUERQUE, NM 87199-5590
(505) 818-9247
(505) 217-3950
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD2006-0166
NM
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD2006-0166
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2006-0166
LICENSE NUMBER
NM
Enumeration date
08/20/2006
Last updated
07/26/2014
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