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General NPI Number Information
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NPI Number | 1457701799
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Entity Type | Organization
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Legal Business Name | MASON MEDICAL GROUP PC
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 10/02/2019
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Provider Practice Location Address
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Address Line | 710 TEMPLE ST
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City | MASON
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State | MI
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Zip | 48854-8624
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Country | US
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Telephone | 517-244-1000
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Fax | 517-244-1030
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Provider Business Mailing Address
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Address Line | 710 TEMPLE ST
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City | MASON
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State | MI
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Zip | 48854-8624
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Country | US
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Telephone | 517-244-1000
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Fax | 517-604-6154
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY S DEWEERD
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Credential | D.O.
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Telephone | 517-244-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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