Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2688 | AK |
NPI | 1750304184 |
---|---|
Provider Name | Bret Lloyd Mason |
First Address | Anchorage, AK 99508-2953 |
Second Address | Anchorage, AK 99508-2953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |