Provider Demographics
NPI:1033180922
Name:MASTERSON, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:MASTERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 CROCKETT DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5902
Mailing Address - Country:US
Mailing Address - Phone:325-203-5190
Mailing Address - Fax:833-580-1224
Practice Address - Street 1:569 SKYLINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3931
Practice Address - Country:US
Practice Address - Phone:731-427-7888
Practice Address - Fax:731-265-4152
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0098207X00000X
TNMD0000031271207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841246Medicaid
TN200035012Medicare PIN
TN1141740001Medicare NSC
TN3841246Medicare PIN
TN3841246Medicaid