Basic Information
| Provider Information | |||||||||
| NPI: | 1235490061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NICHOLAS H. MAST, M.D., INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 ALPINE LILY PL | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949031090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153536380 | ||||||||
| FaxNumber: | 4153536462 | ||||||||
| Practice Location | |||||||||
| Address1: | 1199 BUSH ST | ||||||||
| Address2: | 300 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153536380 | ||||||||
| FaxNumber: | 4153536462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2012 | ||||||||
| LastUpdateDate: | 10/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | MAST | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4153536380 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A98951 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.