Individual
CHARLES MALLENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5169 S COTTONWOOD ST, MURRAY, UT 84107-6767
(801) 507-3513
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
180838-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D0022
—
UT
01
—
P00214602
RAILROAD
UT
Enumeration date
03/29/2006
Last updated
11/18/2015
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