Provider Demographics
NPI:1699739607
Name:MASON, REGINALD KAI (MD)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:KAI
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT ANTHONYS WAY STE 105
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4580
Practice Address - Country:US
Practice Address - Phone:618-465-2761
Practice Address - Fax:618-465-4750
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2024-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236379208600000X
IL036169863208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery