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General NPI Number Information
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NPI Number | 1215201215
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Entity Type | Organization
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Legal Business Name | VINCENT D. MALLORY MD., LLC
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 3311 PRESCOTT RD SUITE 316
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3900
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Country | US
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Telephone | 318-487-1717
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Fax | 318-487-1170
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Provider Business Mailing Address
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Address Line | 3311 PRESCOTT RD SUITE 316
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3900
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Country | US
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Telephone | 318-487-1717
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Fax | 318-487-1170
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | CONSTANCE FISHER MALLORY
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Credential |
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Telephone | 318-487-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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