Provider Demographics
NPI:1376694737
Name:MOHR, MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOHR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:700 W IRONWOOD DR
Mailing Address - Street 2:320
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2656
Mailing Address - Country:US
Mailing Address - Phone:208-676-9913
Mailing Address - Fax:208-666-0885
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:320
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-676-9913
Practice Address - Fax:208-666-0885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2024-04-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18113OtherLICENSE