Healthcare Provider Details

I. General information

NPI: 1104985332
Provider Name (Legal Business Name): OREN MASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 EASTERN AVE SE
GRAND RAPIDS MI
49508-2403
US

IV. Provider business mailing address

3206 EASTERN AVE SE
GRAND RAPIDS MI
49508-2403
US

V. Phone/Fax

Practice location:
  • Phone: 616-475-7922
  • Fax: 616-475-7926
Mailing address:
  • Phone: 616-475-7922
  • Fax: 616-475-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301053157
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: