Provider Demographics
NPI:1326013053
Name:MASON, JILL E (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:E
Other - Last Name:MASON-CALLERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1805 SHEA CENTER DR STE 450
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2255
Mailing Address - Country:US
Mailing Address - Phone:303-471-0221
Mailing Address - Fax:303-393-7144
Practice Address - Street 1:9137 RIDGELINE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2394
Practice Address - Country:US
Practice Address - Phone:303-471-0221
Practice Address - Fax:303-393-7144
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30579208000000X
CO45149208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200326100AMedicaid
KS200326100AMedicaid
KSI34486Medicare UPIN