Provider Demographics
NPI:1003503194
Name:PRICE, MASON NIELSEN (DO)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:NIELSEN
Last Name:PRICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 FM 934
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:TX
Mailing Address - Zip Code:76055-4800
Mailing Address - Country:US
Mailing Address - Phone:254-654-4376
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5659
Practice Address - Country:US
Practice Address - Phone:903-315-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10083702390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program