Provider Demographics
NPI:1609916444
Name:MASON, SCOTT A (PA)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:MASON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1100 S VAN DYKE
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9615
Mailing Address - Country:US
Mailing Address - Phone:989-269-9521
Mailing Address - Fax:989-269-5216
Practice Address - Street 1:1080 S VAN DYKE
Practice Address - Street 2:SUITE B
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9635
Practice Address - Country:US
Practice Address - Phone:989-269-6048
Practice Address - Fax:989-269-6174
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601002408OtherSTATE LICENSE