Provider Demographics
NPI:1851333942
Name:MASONHOLDER, BRIAN D (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:MASONHOLDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3855
Mailing Address - Fax:319-358-2791
Practice Address - Street 1:109 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS JUNCTION
Practice Address - State:IA
Practice Address - Zip Code:52738-1014
Practice Address - Country:US
Practice Address - Phone:319-728-2429
Practice Address - Fax:319-728-7600
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080128957OtherRAILROAD MEDICARE
IA0171975Medicaid
D46448Medicare UPIN
IA0171975Medicaid