MEDICARE: DR. KATHLEEN MAHON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	NV3988	NV

General Provider Information

NPI Number	:	1134212467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN MAHON MD

Provider Business Mailing Address
First Line	:	2598 WINDMILL PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5476
Country	:	US
Telephone Number	:	702-896-6043
Fax Number	:	702-896-9591

Provider Business Practice Location Address
First Line	:	9100 W POST RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2418
Country	:	US
Telephone Number	:	702-255-6665
Fax Number	:	702-255-2994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	09/21/2007

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