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NPI Code Detail

MEDICARE: DR. MARIA MASON M.D.

MEDICARE: DR. MARIA 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
1208D00000XGeneral Practice PhysicianE0117AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15J505OTHERARAR BCBS

General Provider Information

NPI Number : 1710903174
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIA MASON M.D.
Provider Business Mailing Address
First Line : PO BOX 17000
Second Line :
City : FORT SMITH
State : AR
Zip : 72917-7000
Country : US
Telephone Number : 479-314-1131
Fax Number : 479-314-1194
Provider Business Practice Location Address
First Line : 1341 W 6TH ST
Second Line :
City : WALDRON
State : AR
Zip : 72958-7642
Country : US
Telephone Number : 479-314-1131
Fax Number : 479-314-1194
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARIA MASON M.D.” Practice Location

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