Provider Demographics
NPI:1679921753
Name:MALLON, SEAN AARON (DO)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:AARON
Last Name:MALLON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 BARNES BLVD
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98438-1303
Mailing Address - Country:US
Mailing Address - Phone:253-982-5688
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER-JBLM
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1303
Practice Address - Country:US
Practice Address - Phone:253-982-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61415634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty