Healthcare Provider Details

I. General information

NPI: 1710681499
Provider Name (Legal Business Name): BROOKE KIEFER MALLOY DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ELIZABETH KIEFER DPM

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 N 9TH AVE
PENSACOLA FL
32503-4500
US

IV. Provider business mailing address

1851 N 9TH AVE
PENSACOLA FL
32503-4500
US

V. Phone/Fax

Practice location:
  • Phone: 850-434-9867
  • Fax:
Mailing address:
  • Phone: 850-434-9867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: