Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD22170 | OR |
NPI | 1013077510 |
---|---|
Provider Name | Dr. John Mark Mhoon |
First Address | Salem, OR 97302-6162 |
Second Address | Salem, OR 97302-6162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 07/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288383 | (05) | OR |
H12077 | (02) | OR |
MD22170 | OR LICENSE (01) | OR |