Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016002656 | IL |
Y | 222Z00000X | Podiatrist | 016002656 | IL |
NPI | 1053328328 |
---|---|
Provider Name | Dr. Sanford Mason |
First Address | Northbrook, IL 60062-2319 |
Second Address | Northbrook, IL 60062-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 05/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016002656 | (05) | IL |
AM9392387 | DEA (01) | |
T38547 | (02) |