Healthcare Provider Details

I. General information

NPI: 1720026024
Provider Name (Legal Business Name): ERIC MASON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N HIGHWAY 27
CLERMONT FL
34711-2411
US

IV. Provider business mailing address

110 N ORLANDO AVE STE 14
MAITLAND FL
32751-5533
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-4800
  • Fax: 352-241-4830
Mailing address:
  • Phone: 407-335-4045
  • Fax: 407-335-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA9103238
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9103238
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: