Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 52804 | AZ |
NPI | 1366626756 |
---|---|
Provider Name | Dr. Eamonn M Mahoney |
First Address | Flagstaff, AZ 86001-1398 |
Second Address | Flagstaff, AZ 86001-1398 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2007 |
Last Update Date | 27/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170672 | (05) | AZ |