Provider Demographics
NPI:1184644627
Name:WILLIAM M MAHON & JEFFREY M KRAUT
Entity Type:Organization
Organization Name:WILLIAM M MAHON & JEFFREY M KRAUT
Other - Org Name:MENDOCINO COAST PEDIATRIC MDCL GRP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-964-5696
Mailing Address - Street 1:510 CYPRESS ST STE D
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5411
Mailing Address - Country:US
Mailing Address - Phone:707-964-5696
Mailing Address - Fax:707-964-6274
Practice Address - Street 1:510 CYPRESS ST STE D
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5411
Practice Address - Country:US
Practice Address - Phone:707-964-5696
Practice Address - Fax:707-964-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79185ZMedicaid
CARHM53843FMedicaid
CA553843Medicare ID - Type Unspecified