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NPI Code Detail

MEDICARE: DEHRYL MASON PH.D.

MEDICARE: DEHRYL MASON PH.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
1103T00000XPsychologist891AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1891OTHERALPH.D.

General Provider Information

NPI Number : 1821099821
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEHRYL MASON PH.D.
Provider Business Mailing Address
First Line : 3001 SCENIC HWY
Second Line :
City : GADSDEN
State : AL
Zip : 35904-3047
Country : US
Telephone Number : 256-546-9265
Fax Number : 256-549-0376
Provider Business Practice Location Address
First Line : 3001 SCENIC HWY
Second Line :
City : GADSDEN
State : AL
Zip : 35904-3047
Country : US
Telephone Number : 256-546-9265
Fax Number : 256-549-0376
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 03/11/2008

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