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1336493428
MALLORY MOODY PUTNAM
LAKELAND, FL
NPI
1336493428
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: FL PA9106745)
Enumeration Date
2012-10-29
Last Update Date
2017-01-30
Business Address
Mrs. MALLORY MOODY PUTNAM PA
2615 FAIRMOUNT AVE
LAKELAND, FL 33803-3159
Phone number: 863-661-3887
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Mailing Address
Mrs. MALLORY MOODY PUTNAM PA
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805-4543
Phone number: 863-687-1100
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