| Doctor Name: | MR. GERARD H MOHAN |
| NPI Number: | 1043302433 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN-BC |
| License Number: | AP2009 |
| Business Practice Address: | 450 S Willard St Suite 115 Cottonwood, AZ - 863266743 |
| Business Phone Number: | 9286345551 |
| Business Fax Number: | 9286345604 |
| Mailing Address: | 1200 N Beaver St, Payer Credentialing FLAGSTAFF |
| State: | AZ |
| Postal Code: | 860013118 |
| Phone Number: | 9287732559 |
| Fax Number: | 9282136292 |
| NPI Enumeration Date: | 09/29/2006 |
| NPI Last Update Date: | 12/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP2009 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |