Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MB06631300 | NJ |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | N8122 | TX |
N | 207Q00000X | Family Doctor | MB06631300 | NJ |
Y | 207Q00000X | Family Doctor | N8122 | TX |
NPI | 1093795478 |
---|---|
Provider Name | David C Mason |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 19/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
219786501 | (05) | TX |
219786502 | (05) | TX |
8105901 | (05) | NJ |
8CS320 | BCBS (01) | TX |
8CS321 | BCBS (01) | TX |
G97802 | (02) | NJ |
P00929176 | RAILROAD MEDICARE (01) | TX |