Healthcare Provider Details

I. General information

NPI: 1487073649
Provider Name (Legal Business Name): CALEB MASTERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 FLORENCE BLVD
FLORENCE AL
35630-2727
US

IV. Provider business mailing address

1949 FLORENCE BLVD
FLORENCE AL
35630-2729
US

V. Phone/Fax

Practice location:
  • Phone: 417-986-6734
  • Fax: 256-768-9187
Mailing address:
  • Phone: 256-415-8100
  • Fax: 256-415-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number1958
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1958
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: