Provider Demographics
NPI:1457701799
Name:MASON MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MASON MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEWEERD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-244-1000
Mailing Address - Street 1:710 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-8624
Mailing Address - Country:US
Mailing Address - Phone:517-244-1000
Mailing Address - Fax:517-604-6154
Practice Address - Street 1:710 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-8624
Practice Address - Country:US
Practice Address - Phone:517-244-1000
Practice Address - Fax:517-244-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty