Provider Demographics
NPI:1245200179
Name:MOHR, JOSEPH ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:MOHR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20220 450TH ST
Mailing Address - Street 2:
Mailing Address - City:PELICAN RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56572-7320
Mailing Address - Country:US
Mailing Address - Phone:218-863-6100
Mailing Address - Fax:218-863-6173
Practice Address - Street 1:211 E MILL ST
Practice Address - Street 2:BOX 737
Practice Address - City:PELICAN RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56572-4234
Practice Address - Country:US
Practice Address - Phone:218-863-6100
Practice Address - Fax:218-863-6173
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8958363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNRO4648Medicare UPIN