Provider Demographics
NPI:1629206065
Name:MAHN, JONATHON PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:PAUL
Last Name:MAHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W JUNIPER AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3915
Mailing Address - Country:US
Mailing Address - Phone:520-417-4590
Mailing Address - Fax:
Practice Address - Street 1:250 W JUNIPER AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3916
Practice Address - Country:US
Practice Address - Phone:520-417-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine