Individual
DR. MARC JEFFREY MALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5347 MAIN ST, STE 102, NEW PORT RICHEY, FL 34652-2506
(727) 845-1343
(727) 845-1343
Mailing address
2975 ROLLING WOODS DR, PALM HARBOR, FL 34683-2131
(727) 784-8060
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME 0037030
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
054865101
—
FL
Enumeration date
06/15/2005
Last updated
02/24/2009
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