Provider Demographics
NPI:1346760261
Name:MURRAY, MALLORY JODY (NMD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:JODY
Last Name:MURRAY
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:JODY
Other - Last Name:BRITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7000 E MAYO BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-6152
Mailing Address - Country:US
Mailing Address - Phone:480-419-9605
Mailing Address - Fax:
Practice Address - Street 1:7000 E MAYO BLVD STE 1020
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-6152
Practice Address - Country:US
Practice Address - Phone:480-419-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1610208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice