Healthcare Provider Details

I. General information

NPI: 1245896489
Provider Name (Legal Business Name): DAVID MASON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 TIMBER RAIL PT STE 100
FOUNTAIN CO
80817-1442
US

IV. Provider business mailing address

280 DAVID L GOLDFEIN ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-0110
  • Fax: 719-365-0111
Mailing address:
  • Phone: 575-572-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021000892
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0076721
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: