Individual
MALLORY KOULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3075 N RESERVE ST STE Q, MISSOULA, MT 59808-1390
(406) 327-1850
(406) 327-1875
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 327-1850
(406) 327-1875
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MED-PHYS-LIC-114887
MT
2085R0202X
Diagnostic Radiology Physician
10983218-1205
UT
Other
Enumeration date
04/25/2017
Last updated
09/27/2022
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