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General NPI Number Information
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NPI Number | 1952571937
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE CENTER WOOSTER INC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 128 E MILLTOWN RD SUITE 205
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City | WOOSTER
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State | OH
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Zip | 44691-6109
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Country | US
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Telephone | 330-345-2008
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Fax | 330-345-0056
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Provider Business Mailing Address
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Address Line | 128 E MILLTOWN RD STE 205
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City | WOOSTER
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State | OH
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Zip | 44691-1276
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Country | US
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Telephone | 330-345-2008
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAYMOND GREGORY MASON
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Credential | M.D.
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Telephone | 330-345-2008
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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 | 35077914M
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License Number State | OH
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