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General NPI Number Information
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NPI Number | 1164426110
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Entity Type | Individual
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Provider Name | JULIA W MASON MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 24850 SE STARK ST SUITE 150
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City | GRESHAM
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State | OR
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Zip | 97030-8316
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Country | US
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Telephone | 503-491-0714
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Fax | 503-674-2834
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Provider Business Mailing Address
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Address Line | 24850 SE STARK ST SUITE 150
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City | GRESHAM
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State | OR
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Zip | 97030-8316
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Country | US
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Telephone | 503-491-0714
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Fax | 503-674-2834
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 163455
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License Number State | OR
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