MEDICARE: DR. JOHN H. MAHON M.D.

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	207X00000X	Orthopaedic Surgery Physician	8295	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	224337 04	OTHER	AZ	STATE AHCCS
2	AZ0053990	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134115975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H. MAHON M.D.

Provider Business Mailing Address
First Line	:	8602 N CARDINAL DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8602 N CARDINAL DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-6102
Country	:	US
Telephone Number	:	480-695-2724
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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