Healthcare Provider Details

I. General information

NPI: 1487553384
Provider Name (Legal Business Name): MASON R SMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2026
Last Update Date: 11/05/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST.
APO AA
32214
US

IV. Provider business mailing address

4450 TROPEA WAY UNIT 2114
JACKSONVILLE FL
32246-8886
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: