Healthcare Provider Details

I. General information

NPI: 1861470007
Provider Name (Legal Business Name): PATRICIA ANN MAHONEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 PERRYTON PKWY STE 101
PAMPA TX
79065-2817
US

IV. Provider business mailing address

3023 PERRYTON PKWY STE 101
PAMPA TX
79065-2817
US

V. Phone/Fax

Practice location:
  • Phone: 806-665-0801
  • Fax: 806-665-8503
Mailing address:
  • Phone: 806-665-0801
  • Fax: 806-665-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.126066
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number103202
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL2439
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number90139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: