William Matthew Mahon, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

G30967 Issued in CA

Practice address

510 Cypress St Ste D
Fort Bragg, CA 95437-5411

Phone

(707) 964-5696

Fax

(707) 964-6274

NPI assigned

Jul 24, 2006

Last updated

Feb 15, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• William M Mahon & Jeffrey M Kraut

  dba Mendocino Coast Pediatric MDCL GRP

  • Pediatric Adolescent Medicine Physician
  • Fort Bragg, CA
  • NPI 1184644627
  Authorized official Same address or phone
• William M Mahon & Jeffrey M Kraut Mendocino Coast Pediatric MDCL GRP

  • Rural Health Clinic/Center
  • Fort Bragg, CA
  • NPI 1346410230
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329264000000",
    "number": "1184646259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SOUTH ST",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375540",
            "telephone_number": "707-964-1251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CYPRESS ST STE D",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375411",
            "telephone_number": "707-964-5696",
            "fax_number": "707-964-6274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHON",
        "first_name": "WILLIAM",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2012-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "G30967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OOG309670",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amber Lopes
• Susana Lopez
• David Grant Lukomsky, PA-C
• Lynette Kline O.D.
• Suzanna Macias, RD
• Michele Maley
• Erika Lynn Malsom, MFT-INTERN
• Mark David Levine MD, Fort Bragg Professional Corporation
• Joseph E Martin, PA
• Lucila Martinez

• Pediatric Adolescent Medicine Physician in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Pediatric Adolescent Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.