Individual
MATTHEW S MALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-5665
(352) 273-8610
Mailing address
701 GROVE RD FL 3, GREENVILLE, SC 29605-4295
(864) 455-1435
(864) 455-1320
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME162398
FL
208600000X
Surgery Physician
LL82869
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118706100
—
FL
Enumeration date
06/18/2019
Last updated
07/30/2023
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