Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 80434 | MA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 80434 | MA |
NPI | 1477581437 |
---|---|
Provider Name | Michael Doyle Mason |
First Address | Brighton, MA 02135-2040 |
Second Address | Brighton, MA 02135-2040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 06/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E65190 | (02) | MA |