Provider Demographics
NPI:1821005992
Name:MASON, ROBERT ANTHONY (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5989
Mailing Address - Country:US
Mailing Address - Phone:970-686-5646
Mailing Address - Fax:970-686-5118
Practice Address - Street 1:1300 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5989
Practice Address - Country:US
Practice Address - Phone:970-686-5646
Practice Address - Fax:970-686-5118
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01329572Medicaid
COMAR4678OtherBLUE CROSS BLUE SHIELD
COMAR4678OtherBLUE CROSS BLUE SHIELD
CO01329572Medicaid