Joseph S Mallov, M.D

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

MD150628 Issued in OR

Practice address

10101 SE Main St
Suite 1001
Portland, OR 97216-2455

Phone

(503) 255-3404

NPI assigned

Feb 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357516800000",
    "number": "1558336958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92900",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972920900",
            "telephone_number": "503-255-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 SE MAIN ST",
            "address_2": "SUITE 1001",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972162455",
            "telephone_number": "503-255-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLOV",
        "first_name": "JOSEPH",
        "middle_name": "S",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-20",
        "last_updated": "2013-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TN",
            "license": "33955",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "OR",
            "license": "MD150628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "460002986",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bailee Mallon
• Michael Dean Mallon
• Mallory Harman Acupuncture LLC
• Jolena Mae Mallory, CRM
• Wayne Martin Mallory, CADCI
• Charles M Malloy, DMD
• Kyle Andrew Malloy, D.M.D.; M.S.
• Maria Malloy, RDH
• Reece Malloy
• Rionna Malloy

• Endocrinology, Diabetes & Metabolism Physician in Portland, OR
• Providers in Portland, OR by specialty
• Endocrinology, Diabetes & Metabolism Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.