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NPI Code Detail

MEDICARE: DR. RICHARD W MASON DO

MEDICARE: DR. RICHARD W MASON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician03682889IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11921614OTHERILBC/BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003809625
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD W MASON DO
Provider Business Mailing Address
First Line : 10 MARTIN AVE STE 225
Second Line :
City : NAPERVILLE
State : IL
Zip : 60540-6590
Country : US
Telephone Number : 630-355-5633
Fax Number : 630-355-5215
Provider Business Practice Location Address
First Line : 1 E COUNTYLINE RD
Second Line :
City : SANDWICH
State : IL
Zip : 60548-2178
Country : US
Telephone Number : 815-786-2722
Fax Number : 815-786-6840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 01/07/2021

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Directions to “ DR. RICHARD W MASON DO” Practice Location

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