Provider Demographics
NPI:1265588784
Name:MASTERS, SAMUEL S (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:MASTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1663 DOMINICAN WAY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1527
Mailing Address - Country:US
Mailing Address - Phone:831-475-5375
Mailing Address - Fax:831-475-7229
Practice Address - Street 1:1663 DOMINICAN WAY
Practice Address - Street 2:SUITE 212
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1527
Practice Address - Country:US
Practice Address - Phone:831-475-5375
Practice Address - Fax:831-475-7229
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG55792207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G557920Medicaid
CAA53032Medicare UPIN
CA00G557920Medicare ID - Type Unspecified
1028060001Medicare NSC