Provider Demographics
NPI:1518151893
Name:MASON, ANDREW DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DANIEL
Last Name:MASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREW
Other - Middle Name:DANIEL
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:501 GOODLETTE RD N
Mailing Address - Street 2:BUILDING C100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5661
Mailing Address - Country:US
Mailing Address - Phone:407-579-1945
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE RD N
Practice Address - Street 2:BUILDING C100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5661
Practice Address - Country:US
Practice Address - Phone:407-579-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67763207P00000X, 207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics