Provider Demographics
NPI:1871746420
Name:WILLIAM K MASK, M.D.
Entity type:Organization
Organization Name:WILLIAM K MASK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MASK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-908-0337
Mailing Address - Street 1:3901 HOUMA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-908-0337
Mailing Address - Fax:
Practice Address - Street 1:3901 HOUMA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-908-0337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA484512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1670189Medicaid
CAA48451OtherPROFESSIONAL LICENSE
LA5W451Medicare PIN