Provider Demographics
NPI:1700252897
Name:RAY, MASON (PA-C)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5501NW 62ND TERR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2412
Mailing Address - Country:US
Mailing Address - Phone:816-842-4440
Mailing Address - Fax:816-285-5062
Practice Address - Street 1:3601 NE RALPH POWELL RD STE D
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2358
Practice Address - Country:US
Practice Address - Phone:816-842-4440
Practice Address - Fax:816-285-5062
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016496033Medicare PIN