Provider Demographics
NPI:1841828092
Name:LOCKE, MALLORY (MD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 SW HIGHWAY 200 STE 502
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-9650
Mailing Address - Country:US
Mailing Address - Phone:352-615-9279
Mailing Address - Fax:
Practice Address - Street 1:9401 SW HIGHWAY 200 STE 502
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9650
Practice Address - Country:US
Practice Address - Phone:352-615-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME169843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology