Provider Demographics
NPI:1366642373
Name:MASON, TIMOTHY P (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:MASON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 W STATE ROAD 426 STE 1101
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8371
Mailing Address - Country:US
Mailing Address - Phone:407-365-9511
Mailing Address - Fax:407-365-9311
Practice Address - Street 1:2645 W STATE ROAD 426 STE 1101
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8371
Practice Address - Country:US
Practice Address - Phone:407-365-9511
Practice Address - Fax:407-365-9311
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery