Healthcare Provider Details

I. General information

NPI: 1386639524
Provider Name (Legal Business Name): MICHAEL JASON MASTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 HOSPITAL DR
CLYDE NC
28721-8027
US

IV. Provider business mailing address

540 HOSPITAL DR
CLYDE NC
28721-8027
US

V. Phone/Fax

Practice location:
  • Phone: 828-456-7343
  • Fax: 828-452-0939
Mailing address:
  • Phone: 828-456-7343
  • Fax: 828-452-0939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26564
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number26564
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: