Provider Demographics
NPI:1134304058
Name:MOHNEY, JOHN LEROY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEROY
Last Name:MOHNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CULLEN PKWY
Mailing Address - Street 2:STE 216
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-9008
Mailing Address - Country:US
Mailing Address - Phone:832-780-3960
Mailing Address - Fax:
Practice Address - Street 1:2304 FULTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-7836
Practice Address - Country:US
Practice Address - Phone:713-228-4505
Practice Address - Fax:713-228-3007
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6502207Q00000X, 208D00000X
TX20144022084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014903Medicaid
TXA67024Medicare UPIN