Healthcare Provider Details

I. General information

NPI: 1942386768
Provider Name (Legal Business Name): JUAN C. MAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 LPGA BLVD STE 355
DAYTONA BEACH FL
32117-7130
US

IV. Provider business mailing address

2500 LEGACY DR STE 200
FRISCO TX
75034-1844
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-1323
  • Fax: 386-676-7448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME0052931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: