Basic Information
| Provider Information | |||||||||
| NPI: | 1568519445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 AIRPARK CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372175200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3918 MONTCLAIR RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | MOUNTAIN BRK | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352132425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057053550 | ||||||||
| FaxNumber: | 2057053554 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | 259293 | NY | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | 21494 | MS | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ZD0900X | 50266 | CO | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 33420 | SC | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 0101248908 | VA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | TM00304 | TX | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 201100136 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 39747 | TN | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 65280 | GA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | MD202065 | LA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 28031 | AL | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ND0900X | ME109290 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ND0900X | E6949 | AR | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ZD0900X | A117138 | CA | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZD0900X | 25MA08898700 | NJ | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 51136315 | 01 | AL | BLUE CROSS | OTHER |