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MALLORY MOODY PUTNAM

License Number: PA9106745

Data As Of 12/22/2024

Profession
Physician Assistant
License
PA9106745
License Status
CLEAR/Active
Qualifications
Prescribing
License Expiration Date
1/31/2026
License Original Issue Date
08/29/2012
Address of Record
1324 Lakeland Hills Blvd
LAKELAND, FL 33805
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)
No
Discipline on File
No
Public Complaint
No

No secondary locations found.


Name Relationship Profession License Effective Date
ABRAHAMSEN, NADIA Supervising Prescribing Practitioner Medical Doctor 108847 02/21/2018
AKKASHIAN, MICHAEL BERNARD Supervising Prescribing Practitioner Medical Doctor 113464 01/08/2016
ALFONSO, ADALBERTO JR Supervising Prescribing Practitioner Medical Doctor 122516 01/08/2016
AMATEA, JOHN M Supervising Prescribing Practitioner Medical Doctor 111903 01/08/2016
ANCHETA, JOEY SALDANA MD Supervising Prescribing Practitioner Medical Doctor 72598 07/05/2017
ANDERSON, JONATHAN OSBORNE Supervising Prescribing Practitioner Medical Doctor 111888 01/08/2016
AREGOOD, JENNIFER JOY Supervising Prescribing Practitioner Medical Doctor 116318 02/01/2016
ARREDONDO, COREY CUMBIE Supervising Prescribing Practitioner Medical Doctor 85016 01/08/2016
BEACH, KEVIN RICHARD Supervising Prescribing Practitioner Medical Doctor 107000 01/08/2016
BHISITKUL, DONNA MARIE Supervising Prescribing Practitioner Medical Doctor 70258 01/08/2016
BLIND, FRED JOSEPH Supervising Prescribing Practitioner Medical Doctor 99282 01/08/2016
BRAR, SARDUL SINGH MD Supervising Prescribing Practitioner Medical Doctor 48371 01/08/2016
BRENNER, ANNETTE MAGNANT Supervising Prescribing Practitioner Medical Doctor 70818 02/21/2020
BROWN, RICHARD Supervising Prescribing Practitioner Medical Doctor 132286 09/14/2017
BUTZ, ABRAHAM F Supervising Prescribing Practitioner Medical Doctor 102668 01/08/2016
CARMAN, MATTHEW WILLIAM Supervising Prescribing Practitioner Medical Doctor 99548 01/08/2016
CAUSEY, ALAN LANE Supervising Prescribing Practitioner Medical Doctor 70284 01/08/2016
CHUNG, CHARLES R Supervising Prescribing Practitioner Medical Doctor 99441 01/08/2016
COKER, PHILLIP RYAN Supervising Prescribing Practitioner Medical Doctor 122260 01/08/2016
COVITZ, SHANNON MIXON Supervising Prescribing Practitioner Osteopathic Physician 11652 02/21/2020
DE LOS SANTOS, JESSE Supervising Prescribing Practitioner Medical Doctor 112913 01/08/2016
DELEON, JASON Supervising Prescribing Practitioner Medical Doctor 122537 02/12/2019
DUBEY, JESSE VINCENT Supervising Prescribing Practitioner Osteopathic Physician 13099 09/01/2018
ESCOWITZ, HAL ETHAN Supervising Prescribing Practitioner Medical Doctor 81690 01/08/2016
FAWSETT, CHARLES ROBINSON II Supervising Prescribing Practitioner Medical Doctor 112904 01/08/2016
FISHER, ROSE MARIE Supervising Prescribing Practitioner Osteopathic Physician 6698 01/08/2016
GILLESPIE, RITA MARGARET MARY Supervising Prescribing Practitioner Osteopathic Physician 13077 02/12/2019
GLUECK, JESSE Supervising Prescribing Practitioner Medical Doctor 136392 08/09/2020
GUGGINO, STEVEN ANTHONY MD Supervising Prescribing Practitioner Medical Doctor 83061 01/08/2016
HABER, TODD SETH Supervising Prescribing Practitioner Medical Doctor 57935 01/08/2016
HANEY, MARISA LIANA Supervising Prescribing Practitioner Medical Doctor 106073 01/08/2016
HEAD, BRIAN CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 122748 01/08/2016
JOHN, TESHY VARUGHESE Supervising Prescribing Practitioner Medical Doctor 125364 01/11/2019
KARP, JULIANA Supervising Prescribing Practitioner Medical Doctor 64823 01/08/2016
LALANI, FARAH NAUSHIR Supervising Prescribing Practitioner Osteopathic Physician 10814 01/08/2016
LASSETER, MEGAN LEIGH MD Supervising Prescribing Practitioner Medical Doctor 109910 01/08/2016
LINDENBLAD, ERIC HAMILTON Supervising Prescribing Practitioner Medical Doctor 43429 01/08/2016
LONGO, JENNIFER ANN Supervising Prescribing Practitioner Medical Doctor 113332 11/04/2019
MARICHAL, JOSE L MD Supervising Prescribing Practitioner Medical Doctor 21830 01/08/2016
MCFARLAND, MICHAEL SCOTT Supervising Prescribing Practitioner Medical Doctor 99023 01/08/2016
MCGLINN, SEAN PATRICK D O Supervising Prescribing Practitioner Osteopathic Physician 9846 01/08/2016
MCKEE, KRISTIN CORY Supervising Prescribing Practitioner Osteopathic Physician 12083 01/08/2016
MELTON, JAMES DAVID III Supervising Prescribing Practitioner Medical Doctor 52100 01/08/2016
MEMON, SUMERA HAROON Supervising Prescribing Practitioner Osteopathic Physician 11668 07/19/2018
MISDARY, JOHN SARATIAL MD Supervising Prescribing Practitioner Medical Doctor 111957 06/28/2018
OLDANO, KAREN THOMAS Supervising Prescribing Practitioner Osteopathic Physician 6570 01/08/2016
OLSON, CHRISTOPHER EARL Supervising Prescribing Practitioner Medical Doctor 91253 01/08/2016
PALIGA, ANDREW Supervising Prescribing Practitioner Medical Doctor 111562 04/19/2019
PATEL, TEJAS Supervising Prescribing Practitioner Osteopathic Physician 13790 04/19/2019
PAYOR, AUSTIN DANIEL Supervising Prescribing Practitioner Osteopathic Physician 10925 04/14/2020
REDDEN, DANYELLE ANN Supervising Prescribing Practitioner Medical Doctor 110215 01/08/2016
REEBER, CLIFF BENJAMIN Supervising Prescribing Practitioner Medical Doctor 73869 01/08/2016
REGAN, TIMOTHY JOHN Supervising Prescribing Practitioner Medical Doctor 94162 01/08/2016
REINHARDT, NEIL CHRISTOPHER Supervising Prescribing Practitioner Medical Doctor 69496 11/04/2019
RHODES, DAVID JOSEPH Supervising Prescribing Practitioner Medical Doctor 106826 01/08/2016
RODGERS, CHRISTOPHER NEILTON MD Supervising Prescribing Practitioner Medical Doctor 99231 01/08/2016
RODRIGUEZ, VASHUN APONTE Supervising Prescribing Practitioner Medical Doctor 104068 01/08/2016
ROLA, ALEXANDER Supervising Prescribing Practitioner Osteopathic Physician 8833 01/08/2016
SALAZAR, MANUEL MAURICIO Supervising Prescribing Practitioner Medical Doctor 36859 01/08/2016
SANTIAGO, RAFAEL Supervising Prescribing Practitioner Medical Doctor 90335 01/08/2016
SCHILLINGER, MATTHEW Supervising Prescribing Practitioner Osteopathic Physician 9191 01/08/2016
SMITH, DAVID JAMES Supervising Prescribing Practitioner Osteopathic Physician 9167 01/08/2016
SPENCER, ANDREW JOSEPH Supervising Prescribing Practitioner Medical Doctor 122767 04/19/2019
SUEN, ANDREA CATHERINE Supervising Prescribing Practitioner Medical Doctor 116964 01/11/2019
TICKETT, SHELLEY SMITH Supervising Prescribing Practitioner Medical Doctor 90313 02/21/2017
VISRAM, FARID NIZARALI Supervising Prescribing Practitioner Medical Doctor 95308 01/08/2016
VU, CHRISTOPHER HUY Supervising Prescribing Practitioner Medical Doctor 109654 01/08/2016
VYTYKAC, ADAM Supervising Prescribing Practitioner Medical Doctor 115497 07/19/2018
WAN, ERIC KUO HSUAN Supervising Prescribing Practitioner Medical Doctor 92490 01/08/2016
WEBSTER, MAUREEN MICHELLE Supervising Prescribing Practitioner Medical Doctor 76488 01/08/2016
WEEKS, SCOTT ROBERT Supervising Prescribing Practitioner Osteopathic Physician 8388 01/08/2016
WISER, ROBERT K Supervising Prescribing Practitioner Medical Doctor 139864 02/21/2020
YICK, ANDREW VAN Supervising Prescribing Practitioner Medical Doctor 109669 01/08/2016
ZACHARIAH, ANISH BABU M D Supervising Prescribing Practitioner Medical Doctor 101413 11/04/2019

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No Continuing Education Hours Received from Approved Providers As Of 12/22/2024



* To find out more about Approved Providers, or ask a provider why the course you took is not yet listed, please visit our Continuing Education Providers page.


** Personal Development is limited to no more than 3 hours per renewal cycle. Any personal development hours in excess of this 3 hour maximum cannot be used for renewal and have been subtracted from the total available for renewal.


Please do not fax proof of Continuing Education hours to the Board Office until you have received your renewal notice in the mail.


For instructions on how to request a license certification of your Florida license to be sent to another state from the Florida Department of Health, please visit the License Certifications web page.