Healthcare Provider Details

I. General information

NPI: 1184787525
Provider Name (Legal Business Name): CARL JEFFRIES MASON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ROY ST SUITE 120
SEATTLE WA
98109-4018
US

IV. Provider business mailing address

24 ROY ST SUITE 120
SEATTLE WA
98109-4018
US

V. Phone/Fax

Practice location:
  • Phone: 805-455-8593
  • Fax: 805-435-1509
Mailing address:
  • Phone: 805-455-8593
  • Fax: 805-435-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD038142E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD038142E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: