Healthcare Provider Details

I. General information

NPI: 1578720926
Provider Name (Legal Business Name): TRAVIS JAYA MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 02/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631
US

IV. Provider business mailing address

1801 16TH ST
GREELEY CO
80631
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-3894
  • Fax: 970-810-3897
Mailing address:
  • Phone: 970-810-3894
  • Fax: 970-810-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number0116028931
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116028931
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD438340
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: