Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036.081401 | IL |
NPI | 1083976211 |
---|---|
Provider Name | Dr. George Robert Mason |
First Address | River Forest, IL 60305-1510 |
Second Address | River Forest, IL 60305-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 13/06/2012 |