Provider Demographics
NPI:1275515744
Name:MASON, JOHN ALBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:MASON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 E 29TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2588
Mailing Address - Country:US
Mailing Address - Phone:979-774-3232
Mailing Address - Fax:979-774-6332
Practice Address - Street 1:2700 E 29TH ST STE 310
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2588
Practice Address - Country:US
Practice Address - Phone:979-774-3232
Practice Address - Fax:979-774-6332
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH2571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00540GMedicare PIN
TX742918182Medicare UPIN