Provider Demographics
NPI:1184697195
Name:MAS, ILDEFONSO J JR (MD)
Entity type:Individual
Prefix:
First Name:ILDEFONSO
Middle Name:J
Last Name:MAS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3181 CORAL WAY
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-858-3494
Mailing Address - Fax:786-497-2725
Practice Address - Street 1:3181 CORAL WAY
Practice Address - Street 2:5TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-858-3494
Practice Address - Fax:786-497-2725
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049087207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47047300Medicaid
FLE60834Medicare UPIN
FL47047300Medicaid