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General NPI Number Information
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NPI Number | 1962680389
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Entity Type | Organization
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Legal Business Name | MARYRITA KAISER MALLET,MD PA
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 116 SANTA FE DR
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City | WEATHERFORD
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State | TX
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Zip | 76086-6548
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Country | US
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Telephone | 817-613-1942
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Fax | 817-341-3882
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Provider Business Mailing Address
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Address Line | PO BOX 1976
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City | WEATHERFORD
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State | TX
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Zip | 76086-7976
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Country | US
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Telephone | 817-613-1942
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Fax | 817-341-3882
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARYRITA KAISER MALLET
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Credential | MD PA
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Telephone | 817-613-1942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | J4322
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License Number State | TX
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