Provider Demographics
NPI:1558491258
Name:MYRON F MASS MD PA
Entity Type:Organization
Organization Name:MYRON F MASS MD PA
Other - Org Name:NORTH FLORIDA ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:F
Authorized Official - Last Name:MASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-733-8200
Mailing Address - Street 1:3636 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4250
Mailing Address - Country:US
Mailing Address - Phone:904-733-8200
Mailing Address - Fax:904-733-9430
Practice Address - Street 1:3636 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE B-2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4250
Practice Address - Country:US
Practice Address - Phone:904-733-8200
Practice Address - Fax:904-733-9430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78585ZMedicare PIN