Provider Demographics
NPI:1710132246
Name:MASON, DONALD EUGENE (DMSC, PA-C, CAQ-PSY)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:EUGENE
Last Name:MASON
Suffix:
Gender:M
Credentials:DMSC, PA-C, CAQ-PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1910 S STAPLEY DR STE 217
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6679
Mailing Address - Country:US
Mailing Address - Phone:602-888-0370
Mailing Address - Fax:480-748-4095
Practice Address - Street 1:1910 S STAPLEY DR STE 217
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6679
Practice Address - Country:US
Practice Address - Phone:602-888-0370
Practice Address - Fax:480-748-4095
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9056363A00000X
FLPA9108479363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant