Provider Demographics
NPI:1508839143
Name:MASON, JONATHON (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:PA-C
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 2040
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-2040
Mailing Address - Country:US
Mailing Address - Phone:808-553-5038
Mailing Address - Fax:808-553-3780
Practice Address - Street 1:30 OKI PLACE
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-553-5038
Practice Address - Fax:808-553-3780
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK659363A00000X
HIAMD-1390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q42988Medicare UPIN
160197Medicare ID - Type Unspecified