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General NPI Number Information
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NPI Number | 1194165662
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Entity Type | Individual
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Provider Name | MALLORY MEYER DO
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Gender | Female
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 07/12/2021
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Provider Practice Location Address
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Address Line | 715 DR MARTIN LUTHER KING JR AVE NE STE 301
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3668
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Country | US
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Telephone | 505-727-7090
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Fax | 505-727-9590
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Provider Business Mailing Address
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Address Line | 3333 S BANNOCK ST STE 350
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City | ENGLEWOOD
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State | CO
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Zip | 80110-2426
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Country | US
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Telephone | 515-643-2261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | R9727
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 60839
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A-2513-21
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License Number State | NM
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