Healthcare Provider Details

I. General information

NPI: 1417969643
Provider Name (Legal Business Name): STEWART W. MASON MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 E ALLUVIAL AVE
FRESNO CA
93720-2608
US

IV. Provider business mailing address

1374 E ALLUVIAL AVE
FRESNO CA
93720-2608
US

V. Phone/Fax

Practice location:
  • Phone: 559-981-2600
  • Fax: 559-981-2610
Mailing address:
  • Phone: 559-981-2600
  • Fax: 559-981-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA72105
License Number StateCA

VIII. Authorized Official

Name: DR. STEWART WILLIAM MASON
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 559-981-2600