Healthcare Provider Details

I. General information

NPI: 1437152774
Provider Name (Legal Business Name): ATHENA C MASON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ATHENA C RICHISON D.O.

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ELM PL STE 160
BROKEN ARROW OK
74012-7816
US

IV. Provider business mailing address

6600 S YALE AVE STE 1400
TULSA OK
74136-3331
US

V. Phone/Fax

Practice location:
  • Phone: 981-455-7777
  • Fax: 918-455-8105
Mailing address:
  • Phone: 888-247-0125
  • Fax: 918-502-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3275
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: