Organization
SOUTHLAKE PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E MASON MD (OWNER)
(817) 442-8900
Entity
Organization
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.)
J4330
TX
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0037EM
BCBSTX GRP NUMBER
TX
Enumeration date
01/31/2008
Last updated
01/31/2008
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