Basic Information
| Provider Information | |||||||||
| NPI: | 1063440048 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLATT | ||||||||
| FirstName: | MASON | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4545 POINT FOSDICK DR NW | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534597000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4545 POINT FOSDICK DR NW | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534597000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 02/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | OS010378L | PA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | OP60210160 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | PL034986 | 01 | PA | MEDICARE-DME NCS | OTHER | P00400345 | 01 | PA | MEDICARE-RAILROAD | OTHER |