Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME52932 | FL |
NPI | 1033273511 |
---|---|
Provider Name | Dr. Miguel A Mas JR. |
First Address | St Augustine, FL 32080-3108 |
Second Address | St Augustine, FL 32080-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 30/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061348700 | (05) | FL |
E49317 | (02) | FL |