Provider Demographics
NPI:1720030273
Name:MASSON, ROBERT LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEON
Last Name:MASSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 REW CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4215
Mailing Address - Country:US
Mailing Address - Phone:407-649-8585
Mailing Address - Fax:407-649-0151
Practice Address - Street 1:2706 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4215
Practice Address - Country:US
Practice Address - Phone:407-649-8585
Practice Address - Fax:407-649-0151
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063598207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140006700OtherMEDICARE RAILROAD PIN
FL261301OtherAVMED PIN
FL46474OtherBLUE CROSS BLUE SHIELD
FLG03902Medicare UPIN
FL45184Medicare ID - Type UnspecifiedMEDICARE GROUP #
FL3948680001Medicare NSC
FL46474OtherBLUE CROSS BLUE SHIELD