Healthcare Provider Details

I. General information

NPI: 1386683191
Provider Name (Legal Business Name): ROBERT S MASTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR SUITE 740
SAN JOSE CA
95124-4100
US

IV. Provider business mailing address

10300 S DE ANZA BLVD
CUPERTINO CA
95014-3030
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-2029
  • Fax: 408-356-5873
Mailing address:
  • Phone: 408-253-3083
  • Fax: 408-253-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA37122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: