Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 03682889 | IL |
Y | 208600000X | Surgeon | 03682889 | IL |
NPI | 1003809625 |
---|---|
Provider Name | Dr. Richard W Mason |
First Address | Naperville, IL 60540-6590 |
Second Address | Sandwich, IL 60548-2178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036082819 | (05) | IL |
1921614 | BC/BS (01) | IL |
F78060 | (02) |