MEDICARE: DR. DAVID B MALLORY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	10466	OK

General Provider Information

NPI Number	:	1093725368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID B MALLORY MD

Provider Business Mailing Address
First Line	:	12105 S WENTWORTH PL
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-4822
Country	:	US
Telephone Number	:	405-691-6219
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 SW 44TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3604
Country	:	US
Telephone Number	:	405-631-1527
Fax Number	:	405-631-9930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/07/2025

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