Individual
DR. MARY MAILLOUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3333 W COMMERCIAL BLVD, STE 210, FT LAUDERDALE, FL 33309-3407
(877) 751-1157
(919) 425-1596
Mailing address
4074 SW 101ST AVE, DAVIE, FL 33328-2205
(954) 476-5891
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME62993
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23714
MEDICARE CORE
FL
05
—
374172900
—
FL
Enumeration date
05/24/2005
Last updated
02/15/2008
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