Provider Demographics
NPI:1295701993
Name:JETT, MASON P (MD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:P
Last Name:JETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-951-8042
Mailing Address - Fax:405-951-8113
Practice Address - Street 1:3300 NW EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-951-8042
Practice Address - Fax:405-951-8113
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2015-05-14
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Provider Licenses
StateLicense IDTaxonomies
OK10480208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100050040AMedicaid
OK100050040AMedicaid
P00204316Medicare PIN
248510818Medicare PIN
OKC95085Medicare UPIN