Basic Information
| Provider Information | |||||||||
| NPI: | 1093725368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLORY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12105 S WENTWORTH PL | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731704822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056916219 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1240 SW 44TH ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056311527 | ||||||||
| FaxNumber: | 4056319930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 10466 | OK | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.