MEDICARE: MALLORY OSTEOPATHIC FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician	40960	CO

General Provider Information

NPI Number	:	1619045473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALLORY OSTEOPATHIC FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	1548 N BOISE AVENUE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-4125
Country	:	US
Telephone Number	:	970-669-9245
Fax Number	:	970-669-9247

Provider Business Practice Location Address
First Line	:	1548 N BOISE AVENUE
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-4125
Country	:	US
Telephone Number	:	970-669-9245
Fax Number	:	970-669-9247

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. PATRICK LAWRENCE MALLORY
Credential	:	DO
Telephone Number	:	970-669-9245

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	01/11/2008

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