Individual
CHERYL A MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Mailing address
2315 8TH ST, LEWISTON, ID 83501-7301
(208) 746-1383
(208) 746-6348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-10915
ID
207Q00000X
Family Medicine Physician
MD000637598
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009174
—
WA
01
—
1386677722
REGENCE BLUESHIELD
ID
05
—
1386677722
—
ID
01
—
177340
L&I
WA
01
—
307956
L & I MEDICAL PROVIDER NETWORK
WA
Enumeration date
07/09/2006
Last updated
08/18/2015
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