Provider Demographics
NPI:1245265958
Name:MASON, RICHARD R (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:MASON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-1415
Mailing Address - Country:US
Mailing Address - Phone:614-761-0555
Mailing Address - Fax:
Practice Address - Street 1:10034 BREWSTER LN
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7571
Practice Address - Country:US
Practice Address - Phone:614-761-0555
Practice Address - Fax:614-761-8937
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007364M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2222526Medicaid
OHMA4019773Medicare ID - Type Unspecified
OH2222526Medicaid