Healthcare Provider Details

I. General information

NPI: 1700011756
Provider Name (Legal Business Name): OSCAR EUGENIO MASTERS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 N GRAND BLVD #205
OKLAHOMA CITY OK
73112-5647
US

IV. Provider business mailing address

10900 HEFNER POINTE DR STE 505
OKLAHOMA CITY OK
73120-5006
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-0001
  • Fax:
Mailing address:
  • Phone: 405-246-0391
  • Fax: 405-246-0392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberBP1-0034952
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberQ0972
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number31056
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: