Healthcare Provider Details

I. General information

NPI: 1528988961
Provider Name (Legal Business Name): LON MANSON, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 5TH AVE
INDIALANTIC FL
32903-3176
US

IV. Provider business mailing address

230 5TH AVE
INDIALANTIC FL
32903-3176
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-7353
  • Fax: 321-503-3131
Mailing address:
  • Phone: 321-723-7353
  • Fax: 321-503-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LON MANSON
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 321-723-7353