Provider Demographics
NPI:1225358666
Name:MASON, JAY W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:W
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LONDONDERRY CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2718
Mailing Address - Country:US
Mailing Address - Phone:775-849-9910
Mailing Address - Fax:
Practice Address - Street 1:105 LONDONDERRY CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2718
Practice Address - Country:US
Practice Address - Phone:775-849-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5389207RC0000X
KY34942207RC0000X
CAG23993207RC0000X
UT169856-1205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A42124Medicare UPIN