Healthcare Provider Details

I. General information

NPI: 1235663022
Provider Name (Legal Business Name): MATTHEW MASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 200
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

32311 WATERFORD CREST LN
FULSHEAR TX
77441-3001
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7650
  • Fax: 985-230-7655
Mailing address:
  • Phone: 281-229-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.327997
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: