Provider Demographics
NPI:1366428666
Name:MASON, CRAIG MARK (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:MARK
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 UNIVERSITY DR S STE 204
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:701-293-9829
Mailing Address - Fax:701-293-0111
Practice Address - Street 1:2829 UNIVERSITY DR S STE 204
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-293-9829
Practice Address - Fax:701-293-0111
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9082207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND22104OtherBLUE CROSS AND BLUE SHIEL
ND11965Medicaid
180045594OtherRAILROAD MEDICARE
0800996OtherMEDICA
MN214T1MAOtherBLUE CROSS AND BLUE SHIEL
MN831015700Medicaid
0144775OtherCIGNA
1031279OtherPREFERRED ONE
SD6300620Medicaid
ND11965Medicaid