MEDICARE: MALLORY ROSE HOLZER PA

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	363A00000X	Physician Assistant		MO

General Provider Information

NPI Number	:	1265399653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY ROSE HOLZER PA

Provider Business Mailing Address
First Line	:	63 CLYDEBANK DR
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-7589
Country	:	US
Telephone Number	:	636-443-9868
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 CLYDEBANK DR
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-7589
Country	:	US
Telephone Number	:	636-443-9868
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ MALLORY ROSE HOLZER PA” Practice Location

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