Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 93-00220 | NC |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 93-00220 | NC |
NPI | 1356323257 |
---|---|
Provider Name | Dr. John Bohannon Mason |
First Address | Charlotte, NC 28209-3239 |
Second Address | Charlotte, NC 28207-1219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 04/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8954898 | (05) | NC |
G15395 | (02) | NC |
N00220 | (05) | SC |