Provider Demographics
NPI:1063528230
Name:MASI, JUAN M (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:MASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14400 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2703
Mailing Address - Country:US
Mailing Address - Phone:941-423-5056
Mailing Address - Fax:941-423-5068
Practice Address - Street 1:14400 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2703
Practice Address - Country:US
Practice Address - Phone:941-423-5056
Practice Address - Fax:941-423-5068
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10715125OtherCAQH
FL28513OtherBC/BS
FL5215095OtherAETNA
FLP00270116OtherRR MEDICARE