Provider Demographics
NPI:1760525901
Name:O'MALLEY, DAVID GERARD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GERARD
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2565
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2565
Mailing Address - Country:US
Mailing Address - Phone:619-461-3200
Mailing Address - Fax:619-461-3201
Practice Address - Street 1:8881 FLETCHER PKWY STE 290
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3136
Practice Address - Country:US
Practice Address - Phone:619-461-3200
Practice Address - Fax:619-461-3201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG559242081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG55924OtherMEDICAL LICENSE