Healthcare Provider Details

I. General information

NPI: 1568453934
Provider Name (Legal Business Name): MATTHEW EDWARD MASTERS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 LOST CREEK BLVD
AUSTIN TX
78746-6133
US

IV. Provider business mailing address

1705 LOST CREEK BLVD
AUSTIN TX
78746-6133
US

V. Phone/Fax

Practice location:
  • Phone: 512-329-0435
  • Fax: 512-329-0435
Mailing address:
  • Phone: 512-329-0435
  • Fax: 512-329-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH4523
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberH4523
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: