1952302655 NPI number — DR. IRVINE MASON M.D.

Table of content: DR. IRVINE MASON M.D. (NPI 1952302655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952302655 NPI number — DR. IRVINE MASON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASON
Provider First Name:
IRVINE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952302655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7685 NW 71ST TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33067-3948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-385-1882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7685 NW 71ST TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33067-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-385-1882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  ME51966 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05-70077 . This is a "UHC MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 07594 . This is a "BLUE CROSS BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 379606000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 062554000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130003183 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 225645 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 408828 . This is a "METRAHEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 289528 . This is a "GREAT WEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 120190200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com