Provider Demographics
NPI:1083654917
Name:MASON, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2901 OHIO BLVD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2239
Mailing Address - Country:US
Mailing Address - Phone:812-234-8261
Mailing Address - Fax:812-234-8262
Practice Address - Street 1:12238 BAYHILL DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9532
Practice Address - Country:US
Practice Address - Phone:317-694-0215
Practice Address - Fax:317-564-8594
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036336A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251930AMedicaid
IN100251930AMedicaid
INM400075520Medicare PIN