MEDICARE: ALAN H MALLACE 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	174400000X	Specialist	9569	AZ
2	207R00000X	Internal Medicine Physician	9569	AZ
3	207RR0500X	Rheumatology Physician	09569	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659341667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN H MALLACE MD

Provider Business Mailing Address
First Line	:	10474 W THUNDERBIRD BLVD
Second Line	:	SUITE 200
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3015
Country	:	US
Telephone Number	:	866-974-2673
Fax Number	:	866-939-2673

Provider Business Practice Location Address
First Line	:	18444 N 25TH AVE
Second Line	:	STE 310
City	:	PHOENIX
State	:	AZ
Zip	:	85023-1266
Country	:	US
Telephone Number	:	866-974-2673
Fax Number	:	866-939-2673

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	10/06/2014

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Directions to “ ALAN H MALLACE MD” Practice Location

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