Individual provider · Type 1 NPI
Mallory Moody Putnam, PA
Medical Physician Assistant · Lakeland, FL
NPI number
1336493428
Active
Practice location
2615 Fairmount Ave
Lakeland, FL 33803-3159
Mailing address
1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA9106745 (FL) |
Medical Physician Assistant: Definition to come...
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About NPI 1336493428
Mallory Moody Putnam, PA's National Provider Identifier is 1336493428, issued on Oct 29, 2012. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Lakeland, FL. The record was last updated on Jan 30, 2017.