Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | J4330 | TX |
N | 208200000X | Surgeon | J4330 | TX |
N | 208600000X | Surgeon | J4330 | TX |
NPI | 1255414272 |
---|---|
Provider Name | Mark E Mason |
First Address | Southlake, TX 76092-6375 |
Second Address | Southlake, TX 76092-6375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
095081802 | (05) | TX |
10028366 | AMERIGROUP PIN (01) | TX |
104535302 | (05) | TX |
118704100 | FIRSTCARE PIN (01) | TX |
1210606 | FIRSTHEALTH PIN (01) | TX |
124156 | SUPERIOR PIN (01) | TX |
7979112 | AETNA PIN (01) | TX |
G49002 | (02) |