Provider Demographics
NPI:1649781048
Name:G MASON GARCIA MD PLLC
Entity type:Organization
Organization Name:G MASON GARCIA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNAE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-886-9779
Mailing Address - Street 1:6565 E CARONDELET DR STE 225
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-3533
Mailing Address - Country:US
Mailing Address - Phone:520-886-9779
Mailing Address - Fax:520-546-4366
Practice Address - Street 1:6565 E CARONDELET DR STE 225
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-3533
Practice Address - Country:US
Practice Address - Phone:520-886-9779
Practice Address - Fax:520-886-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23654174400000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00958353OtherRAIL ROAD MEDICARE
AZ357584Medicaid