Provider Demographics
NPI:1164482881
Name:MASON, KRISTIN D (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 GRANT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4378
Mailing Address - Country:US
Mailing Address - Phone:303-286-2888
Mailing Address - Fax:303-286-4036
Practice Address - Street 1:9025 GRANT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4378
Practice Address - Country:US
Practice Address - Phone:303-286-2888
Practice Address - Fax:303-286-4036
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39837208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11283271Medicaid
COC442158Medicare PIN
COF39582Medicare UPIN