Healthcare Provider Details

I. General information

NPI: 1245887355
Provider Name (Legal Business Name): JONATHAN THOMAS MASON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ALDRICH ST STE 150
AUSTIN TX
78723-3597
US

IV. Provider business mailing address

4802 STAR JASMINE DR
AUSTIN TX
78723-6059
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 147-277-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberU2262
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: