Healthcare Provider Details

I. General information

NPI: 1013900414
Provider Name (Legal Business Name): JONATHAN L MASEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 SHERIDAN ST SUITE C
HOLLYWOOD FL
33021-3564
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-7500
  • Fax: 964-964-8965
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0068250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: