Provider Demographics
NPI:1720899560
Name:BEALL, MASON I
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:I
Last Name:BEALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 WOODKNOLL DR APT 1006
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4922
Mailing Address - Country:US
Mailing Address - Phone:574-835-0094
Mailing Address - Fax:
Practice Address - Street 1:314 WOODKNOLL DR APT 1006
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4922
Practice Address - Country:US
Practice Address - Phone:574-835-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program