Active NPI
Adlai Travis Mast III, MD
- Pediatrics Physician
- Nacogdoches, TX
National Provider Identifier
1730196643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- F5298
- Practice address
- 613 Russell Blvd
Nacogdoches, TX 75965-1247 - Phone
- (936) 560-4650
- Fax
- (936) 560-4989
- NPI assigned
- Aug 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | F5298 | TX | Primary |
Addresses
Primary practice location
613 Russell Blvd
Nacogdoches, TX 75965-1247
Mailing address
613 Russell Blvd
Nacogdoches, TX 75965-1247
Phone (936) 560-4650
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F5298 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1730196643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "613 RUSSELL BLVD",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759651247",
"telephone_number": "936-560-4650",
"fax_number": "936-560-4989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "613 RUSSELL BLVD",
"city": "NACOGDOCHES",
"state": "TX",
"postal_code": "759651247",
"telephone_number": "936-560-4650",
"fax_number": "936-560-4989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAST",
"first_name": "ADLAI",
"middle_name": "TRAVIS",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "F5298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nacogdoches, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.