Provider Demographics
NPI:1760764153
Name:MASON, BENJAMIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:D
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6451 N FEDERAL HWY STE 800
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1409
Mailing Address - Country:US
Mailing Address - Phone:800-586-5022
Mailing Address - Fax:815-933-7090
Practice Address - Street 1:405 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1462
Practice Address - Country:US
Practice Address - Phone:618-549-0721
Practice Address - Fax:618-457-0469
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2023-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2014021727207P00000X
GA72056207P00000X
NJ25MA10391100207P00000X
CT52272207P00000X
MN61640207P00000X
FLME120257207P00000X
WAMD60830186207P00000X
NY266988207P00000X
KS04-40604207P00000X
NH18640207P00000X
CAA135734207P00000X
TNMD0000058008207P00000X
MEMD22061207P00000X
PAMD458235207P00000X
IL036142404207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2124574Medicaid