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General NPI Number Information
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NPI Number | 1386746857
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Entity Type | Individual
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Provider Name | KEITH ALLEN MALLATT O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 719 E 7TH ST
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City | GALENA
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State | KS
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Zip | 66739-1703
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Country | US
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Telephone | 620-783-2191
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Fax | 620-783-1937
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Provider Business Mailing Address
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Address Line | PO BOX 185
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City | GALENA
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State | KS
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Zip | 66739-0185
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Country | US
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Telephone | 620-783-2191
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Fax | 620-783-1937
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | KS 1173-2
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License Number State | KS
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