MEDICARE: DR. RICHARD GARY MASON DPM

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	213E00000X	Podiatrist	5901001579	MI

General Provider Information

NPI Number	:	1902933401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD GARY MASON DPM

Provider Business Mailing Address
First Line	:	PO BOX 309
Second Line	:	3883 74TH ST. N.E.
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:	701-766-1645

Provider Business Practice Location Address
First Line	:	3883 74TH ST. N.E.
Second Line	:	3883 74TH ST. N.E.
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:	701-766-1645

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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