Provider Demographics
NPI:1174969661
Name:BEALE, MALLORY MARIE (MD)
Entity type:Individual
Prefix:MS
First Name:MALLORY
Middle Name:MARIE
Last Name:BEALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-626-9400
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:2020 E 29TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3917
Practice Address - Country:US
Practice Address - Phone:509-626-9400
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60607547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine