Individual
BRADY MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1940 EAST HWY 114 SUITE 150, SOUTHLAKE, TX 76092
(817) 424-3668
(817) 442-8637
Mailing address
1940 HWY 114 SUITE 150, SOUTHLAKE, TX 76092
(817) 424-3668
(817) 442-8637
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
SC006356
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
SC006356
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932493574
NPI
TX
Enumeration date
06/27/2012
Last updated
12/13/2016
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