Provider Demographics
NPI:1306387741
Name:MASON, JOHN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:505-272-8060
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2024-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
COTL.0009022390200000X
NMMD2022-03272084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program