Healthcare Provider Details

I. General information

NPI: 1336124510
Provider Name (Legal Business Name): MARK C MASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 E MCANDREWS RD SUITE 160
MEDFORD OR
97504-5589
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 541-732-7874
  • Fax: 541-732-7875
Mailing address:
  • Phone: 541-732-7874
  • Fax: 541-732-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD160445
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: