Healthcare Provider Details

I. General information

NPI: 1275758039
Provider Name (Legal Business Name): ALEXANDER MICHAEL MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

4743 ARAPAHOE VE STE 202
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 651-495-6600
  • Fax: 651-254-3123
Mailing address:
  • Phone: 303-938-5700
  • Fax: 303-998-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number57002649
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberDR-46397
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number59933
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: