Putnam, Mallory Moody

Putnam, Mallory Moody is an sole proprietor health care provider with primary practice located at 2615 Fairmount Ave , Lakeland FL 33803-3159. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Putnam, Mallory Moody can be contacted via phone (863) 661-3887.

Contact Information

Primary practice address
2615 Fairmount Ave Lakeland FL 33803-3159
Phone: (863) 661-3887
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9106745 Florida

Profile Details

NPI number 1336493428
LBN Legal business name Putnam, Mallory Moody
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 29th, 2012
Last updated Jan 30th, 2017 - about 9 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.

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