MEDICARE: MR. JOSEPH ALLEN MOHR PA-C

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	363AM0700X	Medical Physician Assistant	8958	MN

General Provider Information

NPI Number	:	1245200179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ALLEN MOHR PA-C

Provider Business Mailing Address
First Line	:	20220 450TH ST
Second Line	:
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-7320
Country	:	US
Telephone Number	:	218-863-6100
Fax Number	:	218-863-6173

Provider Business Practice Location Address
First Line	:	211 E MILL ST
Second Line	:	BOX 737
City	:	PELICAN RAPIDS
State	:	MN
Zip	:	56572-4234
Country	:	US
Telephone Number	:	218-863-6100
Fax Number	:	218-863-6173

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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