Provider Demographics
NPI:1609239680
Name:MCINNES, MALLORY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:ANNE
Last Name:MCINNES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:201 N CLYDE MORRIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-425-4165
Practice Address - Fax:386-425-4165
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2022-05-23
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Provider Licenses
StateLicense IDTaxonomies
FLME137213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine