Provider Demographics
NPI:1962606574
Name:MCMAHON, ROB (LICENSED PLUMBER)
Entity type:Individual
Prefix:
First Name:ROB
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:LICENSED PLUMBER
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:MCMAHON
Other - Last Name:PLUMBING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:323 CARROLL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNKERTON
Mailing Address - State:IA
Mailing Address - Zip Code:50626-9752
Mailing Address - Country:US
Mailing Address - Phone:319-822-4429
Mailing Address - Fax:
Practice Address - Street 1:323 CARROLL BLVD
Practice Address - Street 2:
Practice Address - City:DUNKERTON
Practice Address - State:IA
Practice Address - Zip Code:50626-9752
Practice Address - Country:US
Practice Address - Phone:319-822-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0448431Medicaid