Provider Demographics
NPI:1255714705
Name:WILLIAMS ZORN, MALLORY A (MD)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:A
Last Name:WILLIAMS ZORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-853-5300
Mailing Address - Fax:812-858-4660
Practice Address - Street 1:4209 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-853-5300
Practice Address - Fax:812-858-4660
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN 21728390200000X
IN01080447A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program