Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 20858 | NE |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 20858 | NE |
NPI | 1245291236 |
---|---|
Provider Name | Jeffrey M Mahoney |
First Address | Omaha, NE 68103-0755 |
Second Address | Omaha, NE 68114-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 12/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100264481-00 | (05) | NE |
1245291236 | (05) | IA |