Provider Demographics
NPI:1073858213
Name:MALLARI, JOSEPH F (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:F
Last Name:MALLARI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 SW 163RD PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6365
Mailing Address - Country:US
Mailing Address - Phone:971-322-6580
Mailing Address - Fax:
Practice Address - Street 1:7340 SW 163RD PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-6365
Practice Address - Country:US
Practice Address - Phone:971-322-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19459204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine