MEDICARE: DR. JUSTICE MASON PARROTT CRNA

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	367500000X	Certified Registered Nurse Anesthetist	0024165226	VA
2	367500000X	Certified Registered Nurse Anesthetist	AP137554	TX

General Provider Information

NPI Number	:	1972595742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTICE MASON PARROTT CRNA

Provider Business Mailing Address
First Line	:	1025 ASSEMBLY DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2874
Country	:	US
Telephone Number	:	757-401-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 ASSEMBLY DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2874
Country	:	US
Telephone Number	:	757-401-5774
Fax Number	:

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	09/26/2025

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