Healthcare Provider Details

I. General information

NPI: 1295848471
Provider Name (Legal Business Name): JAMES L. MASDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES L MASDON M.D.

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ROWE DR STE B
GUNTERSVILLE AL
35976-7366
US

IV. Provider business mailing address

602 CORLEY AVE
BOAZ AL
35957-5952
US

V. Phone/Fax

Practice location:
  • Phone: 256-571-8450
  • Fax: 256-840-4584
Mailing address:
  • Phone: 256-571-8450
  • Fax: 256-840-4584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number00023577
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: