Provider Demographics
NPI:1285601591
Name:MASON, PETER MILES (DPM)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MILES
Last Name:MASON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:MILES
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2700 E BAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-2468
Mailing Address - Country:US
Mailing Address - Phone:727-535-1919
Mailing Address - Fax:
Practice Address - Street 1:2700 E BAY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-2468
Practice Address - Country:US
Practice Address - Phone:727-535-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-06
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO714213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55410Medicare UPIN
FL3964390001Medicare NSC
87304Medicare ID - Type Unspecified