Provider Demographics
NPI:1720026024
Name:MASON, ERIC (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N ORLANDO AVE
Mailing Address - Street 2:STE 14
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5533
Mailing Address - Country:US
Mailing Address - Phone:407-335-4045
Mailing Address - Fax:407-335-4045
Practice Address - Street 1:210 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2411
Practice Address - Country:US
Practice Address - Phone:352-243-4800
Practice Address - Fax:352-241-4830
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103238207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292194400Medicaid
FLU5195ZMedicare Oscar/Certification
FL292194400Medicaid