Provider Demographics
NPI:1487861233
Name:MASON, STEPHEN WILLIAM (RT (R))
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:MASON
Suffix:
Gender:M
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12384 SHORERIDGE CT
Mailing Address - Street 2:APT F
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2038
Mailing Address - Country:US
Mailing Address - Phone:804-855-7602
Mailing Address - Fax:
Practice Address - Street 1:12384 SHORERIDGE CT
Practice Address - Street 2:APT F
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2038
Practice Address - Country:US
Practice Address - Phone:804-855-7602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3382842471C3401X, 2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography