| The Memory Doctor, Llc | |
|
26540 Ace Ave Ste E-106 Leesburg FL 34748-8279 | |
| (352) 530-2170 | |
| (352) 530-2180 |
| Full Name | The Memory Doctor, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 26540 Ace Ave Ste E-106, Leesburg, Florida |
| Authorized Official Name and Position | Brenda Mason (OFFICE MANAGER) |
| Authorized Official Contact | 3525302170 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Memory Doctor, Llc 26540 Ace Ave Ste E-106 Leesburg FL 34748-8279 Ph: (352) 530-2170 | The Memory Doctor, Llc 26540 Ace Ave Ste E-106 Leesburg FL 34748-8279 Ph: (352) 530-2170 |
| NPI Number | 1265434534 |
|---|---|
| Provider Enumeration Date | 06/01/2005 |
| Last Update Date | 03/29/2021 |
| Certification Date | 03/29/2021 |
| Medicare PECOS PAC ID | 9436142882 |
|---|---|
| Medicare Enrollment ID | O20040403000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265434534 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PY6497 (Florida) | Primary |
| 103T00000X | Psychologist | PY6497 (Florida) | Secondary |
| Provider Name | Douglas J Mason |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750383006 PECOS PAC ID: 6204723612 Enrollment ID: I20131014000629 |
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