Individual
DR. ROBERT L MAHANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 N SAN FRANCISCO ST, FLAGSTAFF, AZ 86001-3236
(928) 779-7000
Mailing address
PO BOX 31012, FLAGSTAFF, AZ 86003-1012
(928) 779-7000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
20847
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110510
APIPA
—
05
—
110510
—
AZ
01
—
1659445062
GROUP NPI
—
01
—
180022943
MEDICARE RAILROAD
—
01
—
290066
MEDICAID GROUP
—
01
—
AZ0380480
BLUE CROSS BLUE SHIELD
AZ
01
—
DG6643
MEDICARE RAILROAD GROUP
—
Enumeration date
04/27/2006
Last updated
04/25/2008
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