Provider Demographics
NPI:1295728707
Name:MASON, ROSE MARY (MD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:MARY
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MORNINGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-2237
Mailing Address - Country:US
Mailing Address - Phone:712-263-6116
Mailing Address - Fax:712-263-6115
Practice Address - Street 1:1820 HWY 30 E
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-2139
Practice Address - Country:US
Practice Address - Phone:712-263-6116
Practice Address - Fax:712-263-6115
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0090290Medicaid
IA0090290Medicaid
A14520Medicare UPIN