Provider Demographics
NPI:1639702277
Name:MASON, TRESOR
Entity Type:Individual
Prefix:
First Name:TRESOR
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 E 4TH AVE UNIT 22
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-8366
Mailing Address - Country:US
Mailing Address - Phone:918-734-8047
Mailing Address - Fax:
Practice Address - Street 1:3003 E 4TH AVE UNIT 22
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-8366
Practice Address - Country:US
Practice Address - Phone:918-734-8047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist