MEDICARE: MR. JOSEPH ALBERT MAHON CP

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	224P00000X	Prosthetist	3054

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245209519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH ALBERT MAHON CP

Provider Business Mailing Address
First Line	:	2120 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2325
Country	:	US
Telephone Number	:	801-972-5270
Fax Number	:	801-606-7346

Provider Business Practice Location Address
First Line	:	2120 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2325
Country	:	US
Telephone Number	:	801-972-5270
Fax Number	:	801-606-7346

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	12/16/2015

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