Healthcare Provider Details

I. General information

NPI: 1255318663
Provider Name (Legal Business Name): PATRICK MASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER BOULEVARD
ADA OK
74820-3439
US

IV. Provider business mailing address

1921 STONECIPHER BOULEVARD
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-421-4570
  • Fax: 580-421-6286
Mailing address:
  • Phone: 580-421-4550
  • Fax: 580-421-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15197
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: