Individual
DR. JOHANNA T MALLARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
108 W TYLER AVE, WEST MEMPHIS, AR 72301-4221
(870) 732-1191
(870) 732-4091
Mailing address
108 W TYLER AVE, WEST MEMPHIS, AR 72301-4221
(870) 732-1191
(870) 732-4091
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E2442
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142052001
—
AR
Enumeration date
04/28/2006
Last updated
10/08/2020
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