Healthcare Provider Details

I. General information

NPI: 1265692057
Provider Name (Legal Business Name): HAROLD CREW MASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 W STATE ST
COLUMBUS OH
43222-1551
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-5000
  • Fax:
Mailing address:
  • Phone: 850-767-3350
  • Fax: 850-767-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57012661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: