Individual
DAVID MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5700 MONROE ST UNIT 206, SYLVANIA, OH 43560-2735
(419) 473-6601
(419) 479-6966
Mailing address
5700 MONROE ST UNIT 206, SYLVANIA, OH 43560-2735
(419) 473-6601
(419) 479-6966
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35050597
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141191
ANTHEM
OH
01
—
00234
PARAMOUNT
OH
01
—
01-03316
UHC
OH
05
—
0565115
—
OH
01
—
0633929
AETNA
OH
01
—
080130446
RRMC
OH
Enumeration date
08/12/2005
Last updated
07/21/2022
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