Basic Information
| Provider Information | |||||||||
| NPI: | 1023537586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALLORY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 W END AVE STE 800 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455400 | ||||||||
| FaxNumber: | 8884686511 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 S 23RD ST | ||||||||
| Address2: | |||||||||
| City: | FORT PIERCE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349504803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7724614000 | ||||||||
| FaxNumber: | 8884686511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2017 | ||||||||
| LastUpdateDate: | 09/15/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 242T00000X | Y | Technologists, Technicians & Other Technical Service Providers | Perfusionist |
No ID Information.