Vincent D Mallory, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

015979 Issued in LA

Practice address

2495 Shreveport Hwy
Pineville, LA 71360-4044

Phone

(318) 466-2106

NPI assigned

Nov 14, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Vincent D Mallory Professional name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healogics Specialty Physicians of Louisiana, LLC

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Lake Charles, LA
  • NPI 1134528623

  LA

  Medicare reassignment NPD
• Cogent Healthcare of Texas, PA

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1992722953

  Family Medicine, LA

  Medicare reassignment NPD
• Hospitalist Medicine Physicians of Texas, PLLC

  • Internal Medicine Physician
  • Humble, TX
  • NPI 1629307095

  Family Medicine, LA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1215918503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2495 SHREVEPORT HWY",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713604044",
            "telephone_number": "318-466-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 SHREVEPORT HWY",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "713604044",
            "telephone_number": "318-466-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "VINCENT",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "015979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1574520",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VINCENT",
            "last_name": "MALLORY",
            "middle_name": "D",
            "prefix": "DR.",
            "credential": "MD LLC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Edward Lytle, BCSAC
• Gwen Normand Maddox, LCSW
• Derek Maggio, PHARMD
• Carlos G Malave, M.D.
• Nasreen Azhar Mallik, MD
• Joy L Mancil, LPN2
• Jason Brian Manin, D.C.
• De'Shonta Renee Manning, PHARMD
• Ramona Leigh Mansell, LCSW
• Merek Marcantel, RPH

• All providers in Pineville, LA
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.