Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD.36290 | AL |
Y | 111NI0900X | Internist | MD.36290 | AL |
N | 207RG0300X | Geriatric Medicine | MD.36290 | AL |
NPI | 1053751362 |
---|---|
Provider Name | Adnan Mallick |
First Address | Dothan, AL 36301-3022 |
Second Address | Dothan, AL 36301-3022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 17/03/2018 |