Provider Demographics
NPI:1841751351
Name:QUALLS, MASON COLE (MD)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:COLE
Last Name:QUALLS
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 1:603 S BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2629
Mailing Address - Country:US
Mailing Address - Phone:813-995-1775
Mailing Address - Fax:813-642-4877
Practice Address - Street 1:603 S BOULEVARD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2629
Practice Address - Country:US
Practice Address - Phone:813-995-1775
Practice Address - Fax:813-642-4877
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1615372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry