MEDICARE: JORDAN MASON

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	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740043967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MASON

Provider Business Mailing Address
First Line	:	2928 GLEN GARY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-7703
Country	:	US
Telephone Number	:	804-929-8093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 GLEN GARY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-7703
Country	:	US
Telephone Number	:	804-929-8093
Fax Number	:

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	01/31/2024

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Directions to “ JORDAN MASON ” Practice Location

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