Healthcare Provider Details

I. General information

NPI: 1083706816
Provider Name (Legal Business Name): DAVID LEE MASTERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 MAPLEWOOD AVE
WINSTON SALEM NC
27103-4001
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-794-3380
  • Fax: 336-794-3378
Mailing address:
  • Phone: 336-716-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9701479
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891141R
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier147RX
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: