Provider Demographics
NPI:1952302655
Name:MASON, IRVINE (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVINE
Middle Name:
Last Name:MASON
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 1:7685 NW 71ST TER
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3948
Mailing Address - Country:US
Mailing Address - Phone:561-385-1882
Mailing Address - Fax:
Practice Address - Street 1:7685 NW 71ST TER
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-3948
Practice Address - Country:US
Practice Address - Phone:561-385-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME519662084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05-70077OtherUHC MEDICARE
FL07594OtherBLUE CROSS BLUE SHIELD FL
FL379606000Medicaid
FL062554000Medicaid
FL130003183OtherRAILROAD MEDICARE
FL225645OtherAVMED
FL408828OtherMETRAHEALTH
FL289528OtherGREAT WEST
FL$$$$$$$$$OtherCHAMPUS
FL40006Medicare ID - Type UnspecifiedGROUP ID
FL$$$$$$$$$OtherCHAMPUS
FL05-70077OtherUHC MEDICARE