Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 0031 | AZ |
Y | 222Z00000X | Podiatrist | 0031 | AZ |
N | 213ES0131X | Foot Surgery | 0031 | AZ |
NPI | 1205016268 |
---|---|
Provider Name | Dr. Samuel Mason |
First Address | Phoenix, AZ 85020-4050 |
Second Address | Phoenix, AZ 85020-4050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 07/11/2007 |