Provider Demographics
NPI:1205079571
Name:TIMOTHY P MASON DPM PA
Entity type:Organization
Organization Name:TIMOTHY P MASON DPM PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:D P M
Authorized Official - Phone:407-365-9511
Mailing Address - Street 1:2645 W STATE ROAD 426 STE 1101
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8371
Mailing Address - Country:US
Mailing Address - Phone:407-365-9511
Mailing Address - Fax:407-365-9311
Practice Address - Street 1:2645 W STATE ROAD 426 STE 1101
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8371
Practice Address - Country:US
Practice Address - Phone:407-365-9511
Practice Address - Fax:407-365-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001354900Medicaid
FL001354900Medicaid
FLBT349Medicare PIN