Healthcare Provider Details

I. General information

NPI: 1043296031
Provider Name (Legal Business Name): ROBERT MASON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

IV. Provider business mailing address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

V. Phone/Fax

Practice location:
  • Phone: 253-984-6403
  • Fax: 253-985-2948
Mailing address:
  • Phone: 253-984-6403
  • Fax: 253-985-2948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1037
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101026897
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOP60102300
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: