MEDICARE: MR. SCOTT A MASON PA

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
1	363AM0700X	Medical Physician Assistant	5601002408	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5601002408	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1609916444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT A MASON PA

Provider Business Mailing Address
First Line	:	1100 S VAN DYKE
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-9615
Country	:	US
Telephone Number	:	989-269-9521
Fax Number	:	989-269-5216

Provider Business Practice Location Address
First Line	:	1080 S VAN DYKE
Second Line	:	SUITE B
City	:	BAD AXE
State	:	MI
Zip	:	48413-9635
Country	:	US
Telephone Number	:	989-269-6048
Fax Number	:	989-269-6174

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	12/08/2017

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Directions to “ MR. SCOTT A MASON PA” Practice Location

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