Provider Demographics
NPI:1609904143
Name:MALLOY, EDWARD DREW (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DREW
Last Name:MALLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2500
Mailing Address - Country:US
Mailing Address - Phone:831-427-3046
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CALIFORNIA SANTA CRUZ STUDENT HEALTH CTR
Practice Address - Street 2:1156 HIGH STREET
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064
Practice Address - Country:US
Practice Address - Phone:831-459-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine