Provider Demographics
NPI:1447450424
Name:MALLOY, JOHN PATRICK IV (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:MALLOY
Suffix:IV
Gender:M
Credentials:DO
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Mailing Address - Street 1:2225 SW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8558
Mailing Address - Country:US
Mailing Address - Phone:954-500-4554
Mailing Address - Fax:954-400-0904
Practice Address - Street 1:4515 WILES RD STE 201
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3414
Practice Address - Country:US
Practice Address - Phone:954-500-4554
Practice Address - Fax:954-400-0904
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2021-11-27
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Provider Licenses
StateLicense IDTaxonomies
PAOS014015207X00000X
PAOT011278207X00000X
MDH70338207X00000X
FLOS11281207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery