Provider Demographics
NPI:1205987401
Name:MASTERS, SCOTT RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RUSSELL
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 1:79-1020 HAUKAPILA ST
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-7922
Mailing Address - Country:US
Mailing Address - Phone:808-322-4818
Mailing Address - Fax:808-322-4817
Practice Address - Street 1:79-1020 HAUKAPILA ST
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7922
Practice Address - Country:US
Practice Address - Phone:808-322-4818
Practice Address - Fax:808-322-4817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1933572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01878431Medicaid
NY46M831Medicare ID - Type Unspecified
NYG33924Medicare UPIN