Healthcare Provider Details

I. General information

NPI: 1639470529
Provider Name (Legal Business Name): SAMANTHA ANN MASON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9922 KEY HAVEN RD
SEMINOLE FL
33777-3816
US

IV. Provider business mailing address

9922 KEY HAVEN RD
SEMINOLE FL
33777-3816
US

V. Phone/Fax

Practice location:
  • Phone: 619-792-2950
  • Fax:
Mailing address:
  • Phone: 619-792-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS24194
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95458
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340435
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15115
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number114546
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: