Individual
MARK E MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 E SOUTHLAKE BLVD, STE 100, SOUTHLAKE, TX 76092-6375
(817) 442-8900
(817) 488-2490
Mailing address
900 E SOUTHLAKE BLVD, STE 100, SOUTHLAKE, TX 76092-6375
(817) 442-8900
(817) 488-2490
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
J4330
TX
208200000X
Plastic Surgery Physician
J4330
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
095081802
—
TX
01
—
10028366
AMERIGROUP PIN
TX
05
—
104535302
—
TX
01
—
118704100
FIRSTCARE PIN
TX
01
—
1210606
FIRSTHEALTH PIN
TX
01
—
124156
SUPERIOR PIN
TX
01
—
7979112
AETNA PIN
TX
Enumeration date
10/23/2006
Last updated
01/11/2012
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