Provider Demographics
NPI:1336301035
Name:MAWYER, JOSEPH R (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:MAWYER
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 1:15450 N TATUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4241
Mailing Address - Country:US
Mailing Address - Phone:888-698-6727
Mailing Address - Fax:602-560-2721
Practice Address - Street 1:15450 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4241
Practice Address - Country:US
Practice Address - Phone:888-698-6727
Practice Address - Fax:602-560-2721
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine