Provider Demographics
NPI:1093844540
Name:MASON, MARY V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:V
Last Name:MASON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8121
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3500
Mailing Address - Fax:314-362-6959
Practice Address - Street 1:4950 CHILDRENS PL
Practice Address - Street 2:WOHL MEDICINE CLINIC 5TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1000
Practice Address - Country:US
Practice Address - Phone:314-362-3500
Practice Address - Fax:314-362-6959
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-07-16
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Provider Licenses
StateLicense IDTaxonomies
MO106125208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74823Medicare UPIN