Provider Demographics
NPI:1679556518
Name:MASON, MARSHA (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W PRINCE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-3526
Mailing Address - Country:US
Mailing Address - Phone:520-670-3909
Mailing Address - Fax:520-388-7170
Practice Address - Street 1:320 W PRINCE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-3526
Practice Address - Country:US
Practice Address - Phone:520-670-3909
Practice Address - Fax:520-388-7170
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11953208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ202911Medicaid
AZF23760Medicare UPIN
AZ202911Medicaid