Healthcare Provider Details

I. General information

NPI: 1750290656
Provider Name (Legal Business Name): MASON MALONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-3845 COMBAT MEDIC DRIVE
FORT BRAGG NC
28310-9610
US

IV. Provider business mailing address

5-3845 COMBAT MEDIC DRIVE
FORT BRAGG NC
28310-9610
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-2250
  • Fax:
Mailing address:
  • Phone: 910-907-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number6732-4487-34
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: