Individual
MR. KEVIN L MALLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
149 4TH AVE N, OKANOGAN, WA 98840-9437
(509) 422-7230
Mailing address
PO BOX 4110, OMAK, WA 98841-4110
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10004352
WA
Other
Enumeration date
08/08/2007
Last updated
08/08/2007
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