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NPI Code Detail

MEDICARE: JOHN MOUGIN M.D.

MEDICARE: JOHN MOUGIN 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
1207R00000XInternal Medicine Physician23705AZ

Other Identifiers

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

General Provider Information

NPI Number : 1851387278
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MOUGIN M.D.
Provider Business Mailing Address
First Line : 1200 N BEAVER ST
Second Line : PAYER CREDENTIALING
City : FLAGSTAFF
State : AZ
Zip : 86001-3118
Country : US
Telephone Number : 928-773-2559
Fax Number : 928-213-6292
Provider Business Practice Location Address
First Line : 1200 N BEAVER ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86001-3118
Country : US
Telephone Number : 928-214-2920
Fax Number : 928-214-2925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 03/15/2017

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