1205079571 NPI number — TIMOTHY P MASON DPM PA

Table of content: (NPI 1205079571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205079571 NPI number — TIMOTHY P MASON DPM PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY P MASON DPM PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FOOT AND ANKLE SPECIALISTS OF ORLANDO
Provider Other Organization Name Type Code:
3
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:
1205079571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2645 W STATE ROAD 426 STE 1101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-8371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-365-9511
Provider Business Mailing Address Fax Number:
407-365-9311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2645 W STATE ROAD 426 STE 1101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-8371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-365-9511
Provider Business Practice Location Address Fax Number:
407-365-9311
Provider Enumeration Date:
04/15/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
407-365-9511

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO3355 , 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: 001354900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023309200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".