MEDICARE: SEAN AARON MALLON D.O

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	OP61415634	WA

General Provider Information

NPI Number	:	1679921753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN AARON MALLON D.O

Provider Business Mailing Address
First Line	:	690 BARNES BLVD
Second Line	:
City	:	JOINT BASE LEWIS MCCHORD
State	:	WA
Zip	:	98438-1303
Country	:	US
Telephone Number	:	253-982-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER-JBLM
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-1303
Country	:	US
Telephone Number	:	253-982-5688
Fax Number	:

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

Provider Enumeration Date	:	05/30/2016
Last Update Date	:	07/31/2023

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