MEDICARE: ALISON L MALL M.D.

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	207V00000X	Obstetrics & Gynecology Physician	33025	IA
2	207V00000X	Obstetrics & Gynecology Physician	DR.0039729	CO

General Provider Information

NPI Number	:	1891773149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON L MALL M.D.

Provider Business Mailing Address
First Line	:	611 MITCHELL WAY
Second Line	:	SUITE 103
City	:	ERIE
State	:	CO
Zip	:	80516-5441
Country	:	US
Telephone Number	:	303-269-2780
Fax Number	:	303-269-2790

Provider Business Practice Location Address
First Line	:	611 MITCHELL WAY
Second Line	:	SUITE 103
City	:	ERIE
State	:	CO
Zip	:	80516-5441
Country	:	US
Telephone Number	:	303-269-2780
Fax Number	:	303-269-2790

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	10/18/2013

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