Provider Demographics
NPI:1134148612
Name:MAS, LUIS L (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:L
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 1:15106 SW 20TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5679
Mailing Address - Country:US
Mailing Address - Phone:305-401-7451
Mailing Address - Fax:305-223-7126
Practice Address - Street 1:42 NW 27TH AVE
Practice Address - Street 2:SUITE # 401
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-5127
Practice Address - Country:US
Practice Address - Phone:305-642-9997
Practice Address - Fax:305-642-9520
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91436208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3391ZMedicare PIN
FLU3391Medicare PIN
FLI17921Medicare UPIN
FLU3391YMedicare PIN