Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | F3229 | TX |
NPI | 1043261845 |
---|---|
Provider Name | Richard Mason |
First Address | Fredericksburg, TX 78624-7020 |
Second Address | Kerrville, TX 78028-5329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 26/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136306104 | (05) | TX |
C18915 | (02) | TX |