Provider Demographics
NPI:1013900414
Name:MASEL, JONATHAN L (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:MASEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:4030 SHERIDAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3564
Practice Address - Country:US
Practice Address - Phone:954-961-7500
Practice Address - Fax:964-964-8965
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0068250208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47906OtherUNIVERSAL
FL49553OtherBLUE CROSS BLUE SHIELD
FL271579113Medicaid
FL5569129OtherCIGNA
FL260308000Medicaid
FLP00291170OtherRAILROAD MEDICARE
FL034267OtherNHP
FLF00204313202OtherUNITED HEALTHCARE
FL271725OtherAVMED
FL7919362OtherAETNA
FL260308000Medicaid
FL49553OtherBLUE CROSS BLUE SHIELD