Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E-1999 | CA |
Y | 222Z00000X | Podiatrist | E-1999 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E1999 | CA |
NPI | 1538111315 |
---|---|
Provider Name | Dr. William Henry Mason |
First Address | Santa Rosa, CA 95403-5709 |
Second Address | Santa Rosa, CA 95403-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 24/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11127 | (02) |