Provider Demographics
NPI:1710979554
Name:MASON, CHRISTOPHER C (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:C
Last Name:MASON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 W LAKE MARY BLVD
Mailing Address - Street 2:125
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3315
Mailing Address - Country:US
Mailing Address - Phone:497-333-3668
Mailing Address - Fax:407-333-0219
Practice Address - Street 1:4106 W LAKE MARY BLVD
Practice Address - Street 2:125
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3315
Practice Address - Country:US
Practice Address - Phone:497-333-3668
Practice Address - Fax:407-333-0219
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2010-07-09
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
FLPO1884213ES0103X
FLPO-0001884332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
59-3027964OtherTAXPAYER IDENTIFICATION NUMBER
FL052045400Medicaid
FL052045400Medicaid