Provider Demographics
NPI:1134296387
Name:MALLEN, PETER REEVES (MD, FRCS(C), FACS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:REEVES
Last Name:MALLEN
Suffix:
Gender:M
Credentials:MD, FRCS(C), FACS
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Mailing Address - Street 1:11606 HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9273
Mailing Address - Country:US
Mailing Address - Phone:661-665-2363
Mailing Address - Fax:661-663-7657
Practice Address - Street 1:11606 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9273
Practice Address - Country:US
Practice Address - Phone:661-665-2363
Practice Address - Fax:661-663-7657
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CACA28610208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology