Individual
MR. THOMAS A. MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-025137
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051519076
BLUE CROSS
AL
05
—
051553683
—
AL
05
—
168012
—
AL
01
—
510-35357
BCBS
AL
01
—
P01471421
MEDICARE RR
AL
Enumeration date
05/16/2006
Last updated
09/23/2019
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