Provider Demographics
NPI:1437693520
Name:MAHONEY, EUGENE LEE (LAC, EAMP)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:LEE
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10032 15TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3728
Mailing Address - Country:US
Mailing Address - Phone:206-714-0522
Mailing Address - Fax:
Practice Address - Street 1:10032 15TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-3728
Practice Address - Country:US
Practice Address - Phone:206-714-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60695381171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist