William M Mahon & Jeffrey M Kraut Mendocino Coast Pediatric MDCL GRP

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

553843 Issued in CA

Legal business name

WILLIAM M MAHON & JEFFREY M KRAUT MENDOCINO COAST PEDIATRIC MDCL GRP

Practice address

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

Phone

(707) 964-5696

Fax

(707) 964-6274

NPI assigned

Mar 6, 2008

Organization subpart

No

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

Authorized official

Name

William Matthew Mahon, M.D.

Title

Partner/Administrator

Phone

(707) 964-5696

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1346410230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "WILLIAM M MAHON & JEFFREY M KRAUT MENDOCINO COAST PEDIATRIC MDCL GRP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "MAHON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PARTNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "707-964-5696",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "553843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53843F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Faye Whatley, IHP
• Sheri Lynn White-Hackley, PT
• Katharine L. White, LMFT
• Neil Steven Wilensky, D.D.S.
• William M Mahon & Jeffrey M Kraut
• Matthew Simon Winslow
• John Wiser, MFT
• Womens Health Center
• Jocelyn Woodason
• John Clarendon Worthington, RN

• Rural Health Clinic/Center in Fort Bragg, CA
• Providers in Fort Bragg, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; 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.