Provider Demographics
NPI:1760462881
Name:MASON, EVA M
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:M
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4411 E SOUTHCROSS BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-3726
Mailing Address - Country:US
Mailing Address - Phone:210-648-9500
Mailing Address - Fax:210-648-9504
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:SUITE 311
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-444-9000
Practice Address - Fax:210-444-0006
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXTXH8236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130766202Medicaid
TXE66268Medicare UPIN
TX130766202Medicaid