Individual
TRAVERICK RAYDRAKEYON MASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 COLLEGE DRIVE, SIMMESPORT, LA 71369
(318) 717-4399
Mailing address
PO BOX 69, SIMMESPORT, LA 71369-0069
(318) 717-4399
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
485991
NON EMERGENCY TRANSPORTATION CODE
LA
Enumeration date
04/20/2021
Last updated
04/20/2021
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