Healthcare Provider Details

I. General information

NPI: 1518655828
Provider Name (Legal Business Name): MASON C FARRIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 E BATTLEFIELD ST
SPRINGFIELD MO
65809-3435
US

IV. Provider business mailing address

3525 E BATTLEFIELD ST
SPRINGFIELD MO
65809-3434
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-7600
  • Fax: 417-269-8744
Mailing address:
  • Phone: 417-269-7600
  • Fax: 417-269-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024031075
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: