Provider Demographics
NPI:1396840237
Name:MAHONEY, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29710 URGENT CARE DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9595
Mailing Address - Country:US
Mailing Address - Phone:251-626-3782
Mailing Address - Fax:251-626-0782
Practice Address - Street 1:29710 URGENT CARE DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9595
Practice Address - Country:US
Practice Address - Phone:251-626-3782
Practice Address - Fax:251-626-0782
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23239207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51093689OtherBLUE CROSS
AL93689Medicare PIN
AL930109010Medicare PIN
AL51093689OtherBLUE CROSS