MEDICARE: DR. GAYLE P MASTERSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	29648	AZ

General Provider Information

NPI Number	:	1063626125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE P MASTERSON M.D.

Provider Business Mailing Address
First Line	:	6280 E PIMA ST STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3074
Country	:	US
Telephone Number	:	520-229-0585
Fax Number	:	520-298-7693

Provider Business Practice Location Address
First Line	:	6280 E PIMA ST STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3074
Country	:	US
Telephone Number	:	520-229-0585
Fax Number	:	520-298-7693

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	11/04/2016

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