Provider Demographics
NPI:1508916933
Name:MCMASTER, PAUL BRANDON (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRANDON
Last Name:MCMASTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN CARLOS APACHE HEALTHCARE
Mailing Address - Street 2:103 MEDICINE WAY
Mailing Address - City:PERIDOT
Mailing Address - State:AZ
Mailing Address - Zip Code:85542
Mailing Address - Country:US
Mailing Address - Phone:928-475-1330
Mailing Address - Fax:
Practice Address - Street 1:SAN CARLOS APACHE HEALTHCARE
Practice Address - Street 2:103 MEDICINE WAY
Practice Address - City:PERIDOT
Practice Address - State:AZ
Practice Address - Zip Code:85542
Practice Address - Country:US
Practice Address - Phone:928-475-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0540213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ612285-001Medicaid
AZ5210100001Medicare NSC
AZU88563Medicare UPIN
AZ104464Medicare PIN