Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO714 | FL |
NPI | 1285601591 |
---|---|
Provider Name | Dr. Peter Miles Mason |
First Address | Largo, FL 33771-2468 |
Second Address | Largo, FL 33771-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2006 |
Last Update Date | 17/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T55410 | (02) |