Provider Demographics
NPI:1023090099
Name:MASON, JOHN DAWSON (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAWSON
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 1:4619 E CALLE TUBERIA
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2910
Mailing Address - Country:US
Mailing Address - Phone:480-206-4086
Mailing Address - Fax:
Practice Address - Street 1:1500 S MILL AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6699
Practice Address - Country:US
Practice Address - Phone:480-784-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31338207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860373636OtherHUMANA GROUP
AZAZ0728670OtherBLUECROSS BLUESHIELD GRP
AZ775471Medicaid
AZAW1436OtherHEALTHNET GRP
AZ453051001OtherGROUPHEALTH GRP
AZ3981220OtherEVERCARE GRP