Healthcare Provider Details

I. General information

NPI: 1194044107
Provider Name (Legal Business Name): CHRISTOPHER C. MASON, D.P.M., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4106 W LAKE MARY BLVD SUITE 125
LAKE MARY FL
32746-3315
US

IV. Provider business mailing address

4106 W LAKE MARY BLVD SUITE 125
LAKE MARY FL
32746-3315
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-3668
  • Fax: 407-333-3435
Mailing address:
  • Phone: 407-333-3668
  • Fax: 407-333-3435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO-0001884
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPO-0001884
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO-0001884
License Number StateFL

VIII. Authorized Official

Name: DR. CHRISTOPHER C MASON
Title or Position: PHYSICIAN
Credential: DPM
Phone: 407-333-3668