MEDICARE: GARY MERLIN MASON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD28318	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033172481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MERLIN MASON M.D.

Provider Business Mailing Address
First Line	:	103 W BROADWAY AVE
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37801-4703
Country	:	US
Telephone Number	:	865-273-1752
Fax Number	:	865-273-1755

Provider Business Practice Location Address
First Line	:	1503 E LAMAR ALEXANDER PKWY
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37804-5131
Country	:	US
Telephone Number	:	865-980-5290
Fax Number	:	865-980-5295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	04/19/2019

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