Provider Demographics
NPI:1811018534
Name:MAYO, PAUL R (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:MAYO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N AKERS ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5121
Mailing Address - Country:US
Mailing Address - Phone:559-636-3668
Mailing Address - Fax:559-636-3665
Practice Address - Street 1:116 N AKERS ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5121
Practice Address - Country:US
Practice Address - Phone:559-636-3668
Practice Address - Fax:559-636-3665
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E41220213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADH858ZMedicare UPIN
CA6677440001Medicare NSC
CAU70212Medicare UPIN
CADH858YMedicare UPIN