Provider Demographics
NPI:1073510772
Name:CASON, FREDERICK D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:D
Last Name:CASON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11373 CORTEZ BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5405
Mailing Address - Country:US
Mailing Address - Phone:352-597-0224
Mailing Address - Fax:352-597-0252
Practice Address - Street 1:11373 CORTEZ BLVD STE 208
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5405
Practice Address - Country:US
Practice Address - Phone:352-597-0224
Practice Address - Fax:352-597-0252
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086364208600000X
MO2005019363208600000X
GA071217208600000X
CAG45132208600000X
FLME129329208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0031445428BMedicaid
GA003144542AMedicaid
OHD88658Medicare UPIN
GA0031445428BMedicaid