Provider Demographics
NPI:1366885899
Name:MANSON, LON (MD)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:
Last Name:MANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3176
Mailing Address - Country:US
Mailing Address - Phone:321-723-7353
Mailing Address - Fax:
Practice Address - Street 1:230 5TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3176
Practice Address - Country:US
Practice Address - Phone:321-723-7353
Practice Address - Fax:321-503-3131
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME154082207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine