Provider Demographics
NPI:1942386768
Name:MAS, JUAN C (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:MAS
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 1:785 W GRANADA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9522
Mailing Address - Country:US
Mailing Address - Phone:386-673-1323
Mailing Address - Fax:386-676-7448
Practice Address - Street 1:785 W GRANADA BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5163
Practice Address - Country:US
Practice Address - Phone:386-673-1323
Practice Address - Fax:386-676-7448
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052931207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98931Medicare ID - Type Unspecified
FLF35019Medicare UPIN