Provider Demographics
NPI:1871606434
Name:MASON, OLIVER LEE (MD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:LEE
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10650 REAGAN ST
Mailing Address - Street 2:610
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-8800
Mailing Address - Country:US
Mailing Address - Phone:562-982-0010
Mailing Address - Fax:562-431-1319
Practice Address - Street 1:10802 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1505
Practice Address - Country:US
Practice Address - Phone:562-982-0010
Practice Address - Fax:562-982-0012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG564620Medicaid
A93437Medicare UPIN
CAOOG564620Medicaid