Provider Demographics
NPI:1164426110
Name:MASON, JULIA W (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:W
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JULIA
Other - Middle Name:R
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:24850 SE STARK ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8316
Mailing Address - Country:US
Mailing Address - Phone:503-491-0714
Mailing Address - Fax:503-674-2834
Practice Address - Street 1:24850 SE STARK ST
Practice Address - Street 2:SUITE 150
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8316
Practice Address - Country:US
Practice Address - Phone:503-491-0714
Practice Address - Fax:503-674-2834
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163455208000000X
WI42943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500660445Medicaid
WI34053400Medicaid
OR500660445Medicaid