Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD 1054 | ME |
Y | 222Z00000X | Podiatrist | POD 1054 | ME |
NPI | 1003917337 |
---|---|
Provider Name | Dr. Kimberly S. Mason |
First Address | Readfield, ME 04355-3125 |
Second Address | Readfield, ME 04355-3125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |