Mallare, Johanna T
Mallare, Johanna T is an individual health care provider with primary practice located at 108 W Tyler Ave , West Memphis AR 72301-4221. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Mallare, Johanna T can be contacted via phone (870) 732-1191.Contact Information
Primary practice address
108 W Tyler Ave
West Memphis AR 72301-4221
Phone: (870) 732-1191
Fax: (870) 732-4091
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | E2442 | Arkansas |
Profile Details
| NPI number | 1821055278 |
|---|---|
| LBN Legal business name | Mallare, Johanna T |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 28th, 2006 |
| Last updated | Oct 8th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821055278 | NPPES |
| Arkansas | MEDICAID | 142052001 |
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