Provider Demographics
NPI:1083402663
Name:MALLERY, ALYSAN BROOKE (MD)
Entity type:Individual
Prefix:DR
First Name:ALYSAN
Middle Name:BROOKE
Last Name:MALLERY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ALYSAN
Other - Middle Name:BROOKE
Other - Last Name:STAUFFACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18511 HIGHLANDER MEDICS ST
Mailing Address - Street 2:MCHM-DOS-GSR
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79906
Mailing Address - Country:US
Mailing Address - Phone:915-742-0730
Mailing Address - Fax:915-742-7889
Practice Address - Street 1:18511 HIGHLANDER MEDICS ST
Practice Address - Street 2:MCHM-DOS-GSR
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79906
Practice Address - Country:US
Practice Address - Phone:915-742-0730
Practice Address - Fax:915-742-7889
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider