Provider Demographics
NPI:1780904987
Name:MASON, KRISTIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:MARIE
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5606 SW LEE BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9688
Mailing Address - Country:US
Mailing Address - Phone:580-531-6455
Mailing Address - Fax:580-531-6493
Practice Address - Street 1:5606 SW LEE BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9688
Practice Address - Country:US
Practice Address - Phone:580-531-6455
Practice Address - Fax:580-531-6493
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200331310AMedicaid
OK200331310AMedicaid