Provider Demographics
NPI:1770862674
Name:MASON, JIM (PD)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4415
Mailing Address - Country:US
Mailing Address - Phone:469-221-8120
Mailing Address - Fax:469-221-8120
Practice Address - Street 1:250 W HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-4415
Practice Address - Country:US
Practice Address - Phone:469-221-8120
Practice Address - Fax:469-221-8120
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist