Healthcare Provider Details

I. General information

NPI: 1437292976
Provider Name (Legal Business Name): GREGORY MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST 3RD STREET
DULUTH MN
55805
US

IV. Provider business mailing address

400 EAST 3RD STREET
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49567
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49567
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: