Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1094 | ME |
Y | 207QA0505X | Family Doctor - Adult Medicine | 1094 | ME |
NPI | 1093882102 |
---|---|
Provider Name | Dr. Peter Charles Mason |
First Address | Bath, ME 04530-2833 |
Second Address | West Bath, ME 04530-6320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 19/09/2007 |