Provider Demographics
NPI:1487647285
Name:MASON, PHYLLIS LYNNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:LYNNETTE
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2475
Mailing Address - Country:US
Mailing Address - Phone:318-663-6131
Mailing Address - Fax:
Practice Address - Street 1:655 BIENVILLE CIR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5744
Practice Address - Country:US
Practice Address - Phone:318-238-3652
Practice Address - Fax:318-238-3654
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.11350R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology