Healthcare Provider Details

I. General information

NPI: 1417576034
Provider Name (Legal Business Name): MASON DAVID TIPPY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ROWLAND WAY
NOVATO CA
94945-5009
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 415-209-1522
  • Fax: 415-209-1501
Mailing address:
  • Phone: 415-884-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA200651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: