Provider Demographics
NPI:1174573059
Name:MAHONEY, JAMES JEROME JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JEROME
Last Name:MAHONEY
Suffix:JR
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 1:3112 WINCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-5860
Mailing Address - Country:US
Mailing Address - Phone:305-797-0303
Mailing Address - Fax:305-293-4813
Practice Address - Street 1:1350 DOUGLAS CIR
Practice Address - Street 2:BMA DIALYSIS 1122 KEYS PLAZA
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4536
Practice Address - Country:US
Practice Address - Phone:305-797-0303
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20354207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01196OtherBLUE SHIELD
FL01196Medicare ID - Type Unspecified
FL01196OtherBLUE SHIELD