Provider Demographics
NPI:1487625851
Name:MASTRAS, DEAN G (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:G
Last Name:MASTRAS
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 1:4230 BRIDGEPORT WAY W STE B
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4335
Mailing Address - Country:US
Mailing Address - Phone:253-779-6325
Mailing Address - Fax:253-627-8792
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 50
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5816
Practice Address - Country:US
Practice Address - Phone:253-851-5155
Practice Address - Fax:253-627-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000290552085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8146888Medicaid
WA8146888Medicaid
F55920Medicare UPIN