Healthcare Provider Details

I. General information

NPI: 1265406367
Provider Name (Legal Business Name): THOMAS P MAHONEY MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 W HENDERSON ST
CLEBURNE TX
76033-4134
US

IV. Provider business mailing address

1663 W HENDERSON ST
CLEBURNE TX
76033-4134
US

V. Phone/Fax

Practice location:
  • Phone: 817-641-4327
  • Fax: 817-641-4337
Mailing address:
  • Phone: 817-641-4327
  • Fax: 817-641-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number51007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: