Provider Demographics
NPI:1346248028
Name:MASON, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
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 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3440
Practice Address - Fax:217-383-3171
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00786292085R0204X
VA01012591622085R0202X
FLME786292085R0202X, 2085R0204X
TN534662085R0202X, 2085R0204X
IL0361430942085R0204X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1346248028Medicaid
FL300108688OtherRR MEDICARE
TNQ017789Medicaid
FL257038600Medicaid
TNP01707185OtherRAILROAD MEDICARE
FL49358OtherBCBS OF FLORIDA
FL49358OtherBCBS OF FLORIDA
TNQ017789Medicaid
FL257038600Medicaid
FLE3053ZMedicare PIN