Provider Demographics
NPI:1508857004
Name:MASTERSON, MICHAEL DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
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:PO BOX 5503
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0503
Mailing Address - Country:US
Mailing Address - Phone:541-285-7426
Mailing Address - Fax:541-357-4494
Practice Address - Street 1:940 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2208
Practice Address - Country:US
Practice Address - Phone:541-344-2600
Practice Address - Fax:541-344-3317
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16459207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008552Medicaid
OROOWCGHVEMedicare ID - Type Unspecified
OR008552Medicaid
D46039Medicare UPIN