Provider Demographics
NPI:1700936820
Name:PAUL B MCMASTER DPM, PC
Entity Type:Organization
Organization Name:PAUL B MCMASTER DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:MCMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-348-3700
Mailing Address - Street 1:2270 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4081
Mailing Address - Country:US
Mailing Address - Phone:928-348-3700
Mailing Address - Fax:
Practice Address - Street 1:2270 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4081
Practice Address - Country:US
Practice Address - Phone:928-348-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0540213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ612285-001Medicaid
AZ6191870001Medicare NSC
AZ104464Medicare PIN
AZ612285-001Medicaid