Provider Demographics
NPI:1245209519
Name:MAHON, JOSEPH ALBERT (CP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALBERT
Last Name:MAHON
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2325
Mailing Address - Country:US
Mailing Address - Phone:801-972-5270
Mailing Address - Fax:801-606-7346
Practice Address - Street 1:2120 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2325
Practice Address - Country:US
Practice Address - Phone:801-972-5270
Practice Address - Fax:801-606-7346
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3054224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT721608838001Medicaid
UT5704120001Medicare NSC