Healthcare Provider Details

I. General information

NPI: 1194040840
Provider Name (Legal Business Name): KYLE MITCHAM MASTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KYLE M. MASTERS MD

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-5615
  • Fax:
Mailing address:
  • Phone: 314-590-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD198041
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0052924
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60602303
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: