Healthcare Provider Details

I. General information

NPI: 1982671475
Provider Name (Legal Business Name): COLE V MASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 LILLY RD NE STE 250
OLYMPIA WA
98506-5101
US

IV. Provider business mailing address

525 LILLY RD NE STE 250
OLYMPIA WA
98506-5101
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8470
  • Fax: 360-413-8490
Mailing address:
  • Phone: 360-413-8470
  • Fax: 360-413-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00014363
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: