Provider Demographics
NPI:1366522476
Name:MAYO, JOSEPH GRAHAM III (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GRAHAM
Last Name:MAYO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:714-524-3800
Mailing Address - Fax:714-524-5036
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-524-3800
Practice Address - Fax:714-524-5036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65633207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G656330Medicaid
CA00G656330Medicaid
W16082Medicare ID - Type Unspecified