Provider Demographics
NPI:1659481836
Name:MOHR, GARY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:MOHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:730 MACON AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3314
Mailing Address - Country:US
Mailing Address - Phone:719-275-1618
Mailing Address - Fax:719-275-7334
Practice Address - Street 1:730 MACON AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3314
Practice Address - Country:US
Practice Address - Phone:719-275-1618
Practice Address - Fax:719-275-7334
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO24731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD25405Medicare UPIN