Provider Demographics
NPI:1619290400
Name:MASON, WOODIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:WOODIE
Middle Name:LYNN
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 1:115 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7045
Mailing Address - Country:US
Mailing Address - Phone:601-898-0898
Mailing Address - Fax:601-898-0898
Practice Address - Street 1:115 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-7045
Practice Address - Country:US
Practice Address - Phone:601-898-0898
Practice Address - Fax:601-898-0898
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05814208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology