Individual
TIMOTHY J MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1707 GOLD DR S STE 101, FARGO, ND 58103-6413
(701) 280-2033
(701) 232-5578
Mailing address
1707 GOLD DR S STE 101, FARGO, ND 58103-6413
(701) 280-2033
(701) 232-5578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3622
ND
208600000X
Surgery Physician
24007
MN
208600000X
Surgery Physician
Primary
3622
ND
208D00000X
General Practice Physician
3622
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120231
UCARE #
ND
05
—
13390
—
ND
01
—
1700509
MEDICA #
ND
01
—
1700559
MEDICA #
ND
01
—
20698
NDBS #
ND
01
—
2164
NDBS #
ND
01
—
6508
SIOUX VALLEY #
ND
01
—
844548
AMERICA'S PPO/ARAZ #
ND
01
—
DA9011008232
PREFERRED ONE #
ND
01
—
ND20017469
LHS #
ND
Enumeration date
07/10/2006
Last updated
01/12/2024
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