Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 3054 |
NPI | 1245209519 |
---|---|
Provider Name | Mr. Joseph Albert Mahon |
First Address | Salt Lake City, UT 84106-2325 |
Second Address | Salt Lake City, UT 84106-2325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 16/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
721608838001 | (05) | UT |