Provider Demographics
NPI:1568453934
Name:MASTERS, MATTHEW EDWARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:EDWARD
Last Name:MASTERS
Suffix:JR
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 1:1705 LOST CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6133
Mailing Address - Country:US
Mailing Address - Phone:512-329-0435
Mailing Address - Fax:512-329-0435
Practice Address - Street 1:1705 LOST CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6133
Practice Address - Country:US
Practice Address - Phone:512-329-0435
Practice Address - Fax:512-329-0435
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4523207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY0074202OtherDPS NO
TXH4523OtherMEDICAL LICENSE NO
TX131278701Medicaid
TX131278701Medicaid
TXH4523OtherMEDICAL LICENSE NO
TXY0074202OtherDPS NO