Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 17403 | CO |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 17403 | CO |
NPI | 1184752743 |
---|---|
Provider Name | Thomas Harrison Mahony III |
First Address | Colorado Springs, CO 80923 |
Second Address | Colorado Springs, CO 80923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 28/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F00643 | (02) | CO |