Provider Demographics
NPI:1346232774
Name:MASON, CHARLES FARLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FARLEY
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:2 ST. VINCENT CIRCLE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5499
Practice Address - Country:US
Practice Address - Phone:501-552-3000
Practice Address - Fax:501-552-4181
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7122207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1346232774OtherBCBS
AR112607001Medicaid
AR50833Medicare PIN
AR112607001Medicaid