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General NPI Number Information
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NPI Number | 1497890867
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Entity Type | Individual
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Provider Name | MICHAEL W MAHONEY DO
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 134 W 6TH ST
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City | HERMANN
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State | MO
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Zip | 65041-1018
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Country | US
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Telephone | 573-486-5711
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Fax | 573-486-3827
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Provider Business Mailing Address
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Address Line | PO BOX 19
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City | HERMANN
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State | MO
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Zip | 65041-0019
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Country | US
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Telephone | 573-486-1193
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Fax | 573-486-0910
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R6775
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License Number State | MO
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