Provider Demographics
NPI:1386639524
Name:MASTERS, MICHAEL JASON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:MASTERS
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 1:540 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8027
Mailing Address - Country:US
Mailing Address - Phone:828-456-7343
Mailing Address - Fax:828-452-0939
Practice Address - Street 1:540 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8027
Practice Address - Country:US
Practice Address - Phone:828-456-7343
Practice Address - Fax:828-452-0939
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26564207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954667Medicaid
561473220OtherALL OTHER INSURANCE
NC202801AOtherPTAN
54667OtherBLUE CROSS BLUE SHIELD
561473220OtherALL OTHER INSURANCE