Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | E-5877 | AR |
NPI | 1134141484 |
---|---|
Provider Name | Stephen H Mason |
First Address | Hot Springs, AR 71913-6475 |
Second Address | Hot Springs, AR 71913-6475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175507001 | (05) | AR |
E5877 | STATE LICENSE (01) | AR |