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General NPI Number Information
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NPI Number | 1003809625
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Entity Type | Individual
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Provider Name | RICHARD W MASON DO
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Gender | Male
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 1 E COUNTYLINE RD
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City | SANDWICH
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State | IL
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Zip | 60548-2178
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Country | US
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Telephone | 815-786-2722
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Fax | 815-786-6840
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Provider Business Mailing Address
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Address Line | 10 MARTIN AVE STE 225
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City | NAPERVILLE
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State | IL
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Zip | 60540-6590
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Country | US
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Telephone | 630-355-5633
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Fax | 630-355-5215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 03682889
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License Number State | IL
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