Individual provider · Type 1 NPI

Brady Mallory, D.P.M.

Foot & Ankle Surgery Podiatrist · Southlake, TX

NPI number 1992069777 Active

Practice location

1940 East Hwy 114 Suite 150
Southlake, TX 76092

Call (817) 424-3668 Map

Fax (817) 442-8637

Mailing address

1940 Hwy 114 Suite 150
Southlake, TX 76092

Specialties and licenses

TaxonomyCodeLicense
Primary Podiatric Medicine Podiatrist 213EP1101XSC006356 (PA)
Foot & Ankle Surgery Podiatrist Primary 213ES0103XSC006356 (PA)

Foot & Ankle Surgery Podiatrist: Definition to come...

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About NPI 1992069777

Brady Mallory, D.P.M.'s National Provider Identifier is 1992069777, issued on Jun 27, 2012. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Southlake, TX. The record was last updated on Dec 13, 2016.