Provider Demographics
NPI:1235343773
Name:ALVORD, KATHERINE ANNA MASON (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE ANNA
Middle Name:MASON
Last Name:ALVORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNA
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3845 WAYNOKA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6920
Mailing Address - Country:US
Mailing Address - Phone:901-683-4541
Mailing Address - Fax:
Practice Address - Street 1:777 WASHINGTON AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4550
Practice Address - Country:US
Practice Address - Phone:901-523-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45110208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519611Medicaid