Provider Demographics
NPI:1568486884
Name:MASON, JOHN LAWRENCE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:MASON
Suffix:JR
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:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1551
Mailing Address - Country:US
Mailing Address - Phone:601-485-2368
Mailing Address - Fax:601-693-2174
Practice Address - Street 1:1301 20TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4121
Practice Address - Country:US
Practice Address - Phone:601-485-2368
Practice Address - Fax:601-693-2174
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550437Medicaid
ALCH6608OtherRAILROAD GROUP ID
MS180041374OtherRAILROAD MEDICARE
MS00116589Medicaid
AL180041975OtherRAILROAD MEDICARE
MSCH5554OtherRAILROAD MEDICARE GROUP
ALI424Medicare PIN
MS180041374OtherRAILROAD MEDICARE
MS180000242Medicare ID - Type UnspecifiedMEDICARE MISSISSIPPI
ALG36508Medicare UPIN
MSC02590Medicare ID - Type UnspecifiedGROUP PROVIDER ID
AL051550437Medicaid
MS00116589Medicaid
MSCH5554OtherRAILROAD MEDICARE GROUP