Provider Demographics
NPI:1770807224
Name:MASTERS, HEETEN (DO)
Entity type:Individual
Prefix:
First Name:HEETEN
Middle Name:
Last Name:MASTERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3131 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2007
Practice Address - Country:US
Practice Address - Phone:817-375-1413
Practice Address - Fax:817-375-9101
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03559208000000X
390200000X
TXP6029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DX095OtherBCBS
TX325092001Medicaid
TX313537YMJCMedicare PIN