Individual
MARIA D MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
47718
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043623
PREFERRED ONE
—
01
—
132828
U CARE
—
01
—
1701414
MEDICA HEALTH PLANS
—
01
—
2357287
ARAZ GROUP AMERICAS PPO
—
01
—
346G4MA
BLUE CROSS BLUE SHIELD
—
01
—
6D053CE
BLUE CROSS BLUE SHIELD
—
01
—
754479100
MEDICAL ASSISTANCE
—
01
—
HP52031
HEALTH PARTNERS
—
Enumeration date
10/25/2005
Last updated
11/28/2011
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