Doctor Name: | MALLORY KIMSEY |
NPI Number: | 1023466570 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O. |
License Number: | 208D00000X |
Business Practice Address: | 1570 Chukar Rdg Palm Harbor, FL - 346836454 |
Business Phone Number: | 7272156898 |
Business Fax Number: | |
Mailing Address: | 1570 Chukar Rdg, PALM HARBOR |
State: | FL |
Postal Code: | 346836454 |
Phone Number: | 7272156898 |
Fax Number: | |
NPI Enumeration Date: | 05/25/2016 |
NPI Last Update Date: | 05/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 208D00000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |