Provider Demographics
NPI:1366626756
Name:MAHONEY, EAMONN M (MD)
Entity Type:Individual
Prefix:DR
First Name:EAMONN
Middle Name:M
Last Name:MAHONEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1485 N TURQUOISE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1398
Mailing Address - Country:US
Mailing Address - Phone:928-774-7757
Mailing Address - Fax:928-226-3071
Practice Address - Street 1:1485 N TURQUOISE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1398
Practice Address - Country:US
Practice Address - Phone:928-774-7757
Practice Address - Fax:928-226-3071
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2017-09-27
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Provider Licenses
StateLicense IDTaxonomies
AZ52804207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ170672Medicaid
AZ170672Medicaid