Healthcare Provider Details

I. General information

NPI: 1710979554
Provider Name (Legal Business Name): CHRISTOPHER C MASON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date: 03/29/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 497-333-3668
  • Fax: 407-333-0219
Mailing address:
  • Phone: 497-333-3668
  • Fax: 407-333-0219

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 NumberPO1884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: