Healthcare Provider Details

I. General information

NPI: 1912241100
Provider Name (Legal Business Name): ROGER A MASON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HIGHWAY 65 S
DUMAS AR
71639-3006
US

IV. Provider business mailing address

PO BOX 887
DUMAS AR
71639-0887
US

V. Phone/Fax

Practice location:
  • Phone: 870-382-4303
  • Fax:
Mailing address:
  • Phone: 870-382-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGER A. MASON
Title or Position: OWNER
Credential: M.D.
Phone: 870-382-4303