Provider Demographics
NPI:1780987172
Name:EVA M. MASON, MD, PA
Entity type:Organization
Organization Name:EVA M. MASON, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-444-9000
Mailing Address - Street 1:311 CAMDEN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2013
Mailing Address - Country:US
Mailing Address - Phone:210-444-9000
Mailing Address - Fax:
Practice Address - Street 1:311 CAMDEN ST STE 311
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2013
Practice Address - Country:US
Practice Address - Phone:210-444-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8236261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130766202Medicaid
TX130766202Medicaid
TXE66268Medicare UPIN