Provider Demographics
NPI:1356501431
Name:MASTERS, JODY (PA)
Entity Type:Individual
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First Name:JODY
Middle Name:
Last Name:MASTERS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:4316 CARLISLE BLVD NE
Mailing Address - Street 2:STE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4829
Mailing Address - Country:US
Mailing Address - Phone:505-888-1075
Mailing Address - Fax:505-888-1082
Practice Address - Street 1:4316 CARLISLE BLVD NE
Practice Address - Street 2:STE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4829
Practice Address - Country:US
Practice Address - Phone:505-888-1075
Practice Address - Fax:505-888-1082
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2006-0044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant