Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD151488 | OR |
NPI | 1003012303 |
---|---|
Provider Name | Gregory William Mallek |
First Address | Hillsboro, OR 97123-4253 |
Second Address | Hillsboro, OR 97123-4253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2007 |
Last Update Date | 14/04/2016 |