Individual
JOSEPH S MALLOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
10101 SE MAIN ST, SUITE 1001, PORTLAND, OR 97216-2455
(503) 255-3404
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 255-3404
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
33955
TN
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD150628
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
460002986
MEDICARE RAILROAD
—
Enumeration date
02/20/2006
Last updated
01/07/2013
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