Provider Demographics
NPI:1033273511
Name:MAS, MIGUEL A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:A
Last Name:MAS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1301 PLANTATION ISLAND DR S
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3108
Mailing Address - Country:US
Mailing Address - Phone:904-461-1560
Mailing Address - Fax:904-461-4304
Practice Address - Street 1:1301 PLANTATION ISLAND DR S
Practice Address - Street 2:SUITE 404
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3108
Practice Address - Country:US
Practice Address - Phone:904-461-1560
Practice Address - Fax:904-461-4304
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2013-07-30
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Provider Licenses
StateLicense IDTaxonomies
FLME529322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061348700Medicaid
FL061348700Medicaid