Provider Demographics
NPI:1952978116
Name:MASON, GRAHAM WARREN (MD)
Entity type:Individual
Prefix:MR
First Name:GRAHAM
Middle Name:WARREN
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 DOUGLAS ST # 321
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1048
Mailing Address - Country:US
Mailing Address - Phone:917-294-5225
Mailing Address - Fax:
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2024-07-30
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2023-09-19
Provider Licenses
StateLicense IDTaxonomies
IAMD-53165208M00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist