Provider Demographics
NPI:1700252897
Name:RAY, MASON (PA-C)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:RAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:20920 W 151ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7243
Mailing Address - Country:US
Mailing Address - Phone:913-355-7160
Mailing Address - Fax:913-782-1097
Practice Address - Street 1:20920 W 151ST ST STE 100
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7243
Practice Address - Country:US
Practice Address - Phone:913-355-7160
Practice Address - Fax:913-782-1097
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2024-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016496033Medicare PIN