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Individual

ELIJAH MASON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3900 BETHEL DR, SAINT PAUL, MN 55112-6902
(651) 638-6400
Mailing address
1330 HIGH SITE DR APT 218, EAGAN, MN 55121-2737
(612) 718-3950

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
MN
2255A2300X
Athletic Trainer
390200000X
Student in an Organized Health Care Education/Training Program
Primary
MN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
10/12/2021
Last updated
10/12/2021
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