Provider Demographics
NPI:1962403303
Name:MAHONY, PETER MIKE (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MIKE
Last Name:MAHONY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:333 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5887
Mailing Address - Country:US
Mailing Address - Phone:337-478-9331
Mailing Address - Fax:337-478-9828
Practice Address - Street 1:333 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:STE. 220
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5887
Practice Address - Country:US
Practice Address - Phone:337-478-9331
Practice Address - Fax:337-478-9828
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA0216152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1480649Medicaid
LA1480649Medicaid
G02170Medicare UPIN