Provider Demographics
NPI:1952390841
Name:MASON, PHILLIP E (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:E
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:21 SPURS LN
Mailing Address - Street 2:230B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1669
Mailing Address - Country:US
Mailing Address - Phone:210-690-7400
Mailing Address - Fax:
Practice Address - Street 1:21 SPURS LN
Practice Address - Street 2:230B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1669
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5039207P00000X, 207PE0004X, 207RC0200X
OH35.093611207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154188002Medicaid
OH2493798Medicaid
TX154188004Medicaid
TX154188003Medicaid
H55036Medicare UPIN
TX275445YP79Medicare PIN
OH2493798Medicaid
TX154188003Medicaid
TX154188004Medicaid
OH4262252Medicare PIN