Individual
MARY NAN MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
530 S JACKSON ST, DEPARTMENT OF EMERGENCY MEDICINE C1H17, LOUISVILLE, KY 40202-1675
(502) 852-5689
(502) 852-4701
Mailing address
530 S JACKSON ST, DEPARTMENT OF EMERGENCY MEDICINE C1H17, LOUISVILLE, KY 40202-1675
(502) 852-5689
(502) 852-4701
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01039542A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200011050
—
IN
Enumeration date
10/03/2006
Last updated
06/01/2015
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