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Brady Mallory, DPM
Foot & Ankle Surgery Podiatrist in Southlake, Texas
NPI 1992069777

Brady Mallory is a Foot & Ankle Surgery Podiatrist based in Southlake, TX and is specialized in Foot & Ankle Surgery. Brady Mallory practices in Southlake, TX and has the professional credentials of DPM. The NPI Number for Brady Mallory is 1992069777 and holds a License No. SC006356 (Texas).

The current practice location address for Brady Mallory is 1940 East Hwy 114 Suite 150, Southlake, TX and can be reached out via phone at 817-424-3668 and via fax at 817-442-8637.

Location: 1940 East Hwy 114 Suite 150, Southlake, TX, 76092
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1992069777
Provider Name
Brady Mallory
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
1940 East Hwy 114 Suite 150, Southlake, TX, 76092
Phone Number
817-424-3668
Fax Number
817-442-8637
Provider Enumeration Date
06/27/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1932493574 01 TX NPI
institution
Provider Business Practice Location Address Details
Address
1940 East Hwy 114 Suite 150
City
Southlake
State
Texas
Zip
76092
Phone Number
817-424-3668
Fax Number
817-442-8637
person
Provider Business Mailing Address Details
Address
1940 East Hwy 114 Suite 150
City
Southlake
State
Texas
Zip
76092
Phone Number
817-424-3668
Fax Number
817-442-8637
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Primary Podiatric Medicine
Taxonomy
213EP1101X
License No.
SC006356 (Pennsylvania)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
213ES0103X
License No.
SC006356 (Pennsylvania)
Definition
Definition to come...
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