Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 453927 | TX |
NPI | 1336237338 |
---|---|
Provider Name | Carlyn B Mason |
First Address | Dallas, TX 75237-3490 |
Second Address | Dallas, TX 75237-3490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 11/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
177846601 | (05) | TX |
Q58122 | (02) | TX |