Provider Demographics
NPI:1063553626
Name:MCMAHON, WILLIAM MARTIN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARTIN
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1970 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1324
Mailing Address - Country:US
Mailing Address - Phone:801-585-7781
Mailing Address - Fax:801-585-9098
Practice Address - Street 1:650 KOMAS DR
Practice Address - Street 2:206
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-1215
Practice Address - Country:US
Practice Address - Phone:801-585-7781
Practice Address - Fax:801-581-8979
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT16022512052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry