Provider Demographics
NPI:1790128197
Name:MAHON, BRIAN HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HENRY
Last Name:MAHON
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0709
Mailing Address - Country:US
Mailing Address - Phone:409-747-2849
Mailing Address - Fax:409-772-7120
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555
Practice Address - Country:US
Practice Address - Phone:409-747-2849
Practice Address - Fax:409-772-7120
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2019-07-24
Deactivation Date:2019-06-21
Deactivation Code:
Reactivation Date:2019-07-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC824592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program