Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0103300915 | VA |
Y | 222Z00000X | Podiatrist | 0103300915 | VA |
NPI | 1063594810 |
---|---|
Provider Name | Dr. John G Mcmahon JR. |
First Address | Midlothian, VA 23112-2200 |
Second Address | Midlothian, VA 23112-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 05/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010091144 | (05) | VA |
5293010001 | MEDICARE DME PROVIDER (01) | VA |
BM7866710 | DEA NUMBER (01) | VA |
U89881 | (02) |