Healthcare Provider Details

I. General information

NPI: 1609874403
Provider Name (Legal Business Name): RAYMOND GREGORY MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E MILLTOWN RD SUITE 205
WOOSTER OH
44691-6109
US

IV. Provider business mailing address

3242 MCCOY RD
WOOSTER OH
44691-8904
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-2008
  • Fax: 330-345-0056
Mailing address:
  • Phone: 330-263-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35077914M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: