Provider Demographics
NPI:1003800525
Name:MASON, PETER H (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:MASON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 STAFFORD SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-6033
Mailing Address - Country:US
Mailing Address - Phone:937-608-0396
Mailing Address - Fax:
Practice Address - Street 1:1632 STAFFORD SPRINGS PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-6033
Practice Address - Country:US
Practice Address - Phone:937-608-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-2819M213ES0103X
FLPO3344213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187888Medicaid
OHH135200Medicare PIN
OH2187888Medicaid
FLK8775Medicare PIN