Healthcare Provider Details

I. General information

NPI: 1851333942
Provider Name (Legal Business Name): BRIAN D MASONHOLDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E WALNUT ST
COLUMBUS JUNCTION IA
52738-1014
US

IV. Provider business mailing address

PO BOX 2027
IOWA CITY IA
52244-2027
US

V. Phone/Fax

Practice location:
  • Phone: 319-728-2429
  • Fax: 319-728-7600
Mailing address:
  • Phone: 319-339-3855
  • Fax: 319-358-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01809
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: