Provider Demographics
NPI:1043244650
Name:DAVID MASON PHD PC
Entity Type:Organization
Organization Name:DAVID MASON PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-725-2686
Mailing Address - Street 1:950 FRANCIS PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2465
Mailing Address - Country:US
Mailing Address - Phone:314-725-2686
Mailing Address - Fax:314-725-2680
Practice Address - Street 1:950 FRANCIS PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2465
Practice Address - Country:US
Practice Address - Phone:314-725-2686
Practice Address - Fax:314-725-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01496231H00000X
MO201191237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO332159417Medicaid
625233OtherHEALTHLINK
3410673/7465525OtherAETNA
MO332159417Medicaid
625233OtherHEALTHLINK