Provider Demographics
NPI:1851431423
Name:MCMAHON, DAVID BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:MCMAHON
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 1:500 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2759
Mailing Address - Country:US
Mailing Address - Phone:321-267-1218
Mailing Address - Fax:321-267-1182
Practice Address - Street 1:500 N WASHINGTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2759
Practice Address - Country:US
Practice Address - Phone:321-267-1218
Practice Address - Fax:321-267-1182
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054961207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE89298Medicare UPIN
FL09410Medicare ID - Type Unspecified