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General NPI Number Information
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NPI Number | 1184752743
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Entity Type | Individual
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Provider Name | THOMAS HARRISON MAHONY III M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 6011 E. WOODMEN RD SUITE 120
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923
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Country | US
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Telephone | 719-574-8383
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Fax | 719-574-8548
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Provider Business Mailing Address
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Address Line | 6011 E. WOODMEN RD SUITE 120
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923
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Country | US
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Telephone | 719-574-8383
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Fax | 719-574-8548
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 17403
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 17403
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License Number State | CO
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