Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 016-004384 | IL |
Y | 213ES0131X | Foot Surgery | N006379 | NY |
NPI | 1124125562 |
---|---|
Provider Name | Dr. Douglas E Mason |
First Address | Clifton Park, NY 12065-3667 |
Second Address | Clifton Park, NY 12065-3667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 19/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0060201289 | BLUE CROSS BLUE SHIELD (01) | IL |
03293698 | (05) | NY |
N006379 | LICENSE (01) | NY |
U18846 | (02) | IL |