Provider Demographics
NPI:1477693281
Name:MCMAHAN, MICHAEL G (PAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84767-0248
Mailing Address - Country:US
Mailing Address - Phone:435-590-8186
Mailing Address - Fax:
Practice Address - Street 1:120 LION BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:UT
Practice Address - Zip Code:84767-0248
Practice Address - Country:US
Practice Address - Phone:435-772-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1005091206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant