Provider Demographics
NPI:1306878764
Name:MASON, ROY CARRINGTON JR (DO)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:CARRINGTON
Last Name:MASON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-563-4641
Practice Address - Street 1:3450 11TH CT STE 303
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-794-9771
Practice Address - Fax:772-794-9773
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15210208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340013731OtherRAIL ROAD MEDICARE
TX001465497OtherUNITED HEALTH
TX122060004Medicaid
TX122060005Medicaid
TX8301777005OtherCIGNA
TX8A9484OtherBLUECROSS BLUESHIELD
TX0957950OtherAETNA
TX122060006Medicaid
TX0006BQMedicare PIN
TX8301777005OtherCIGNA
TX0957950OtherAETNA
TX122060006Medicaid