Provider Demographics
NPI:1851363634
Name:MAHR, RICHARD GERARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GERARD
Last Name:MAHR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-9545
Mailing Address - Fax:651-254-3662
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:MC 11109E
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-9545
Practice Address - Fax:651-254-3662
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-12-12
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Provider Licenses
StateLicense IDTaxonomies
MN36096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN932065200Medicaid
MN932065200Medicaid
MN932065200Medicaid