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General NPI Number Information
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NPI Number | 1700252897
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Entity Type | Individual
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Provider Name | MASON RAY PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 20920 W 151ST ST STE 100
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City | OLATHE
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State | KS
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Zip | 66061-7243
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Country | US
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Telephone | 913-355-7160
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Fax | 913-782-1097
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Provider Business Mailing Address
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Address Line | 20920 W 151ST ST STE 100
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City | OLATHE
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State | KS
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Zip | 66061-7243
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Country | US
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Telephone | 913-355-7160
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Fax | 913-782-1097
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-01827
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License Number State | KS
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