Provider Demographics
NPI:1548425747
Name:MALLOW, GARY W (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:MALLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9633 W BROWARD BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2332
Mailing Address - Country:US
Mailing Address - Phone:954-452-3535
Mailing Address - Fax:954-452-9631
Practice Address - Street 1:9633 W BROWARD BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2332
Practice Address - Country:US
Practice Address - Phone:954-452-3535
Practice Address - Fax:954-452-9631
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL049267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine