Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 52644 | CA |
N | 213EG0000X | General Practice | 52644 | CA |
Y | 1223G0001X | General Practice | DN18531 | FL |
Y | 213EG0000X | General Practice | DN18531 | FL |
NPI | 1003928375 |
---|---|
Provider Name | Dr. Martina Mallery |
First Address | Sarasota, FL 34236-7883 |
Second Address | Sarasota, FL 34236-7883 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/01/2009 |