Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | H4523 | TX |
Y | 111NI0900X | Internist | H4523 | TX |
N | 207RA0401X | Internist - Addiction Medicine | H4523 | TX |
NPI | 1568453934 |
---|---|
Provider Name | Dr. Matthew Edward Masters JR. |
First Address | Austin, TX 78746-6133 |
Second Address | Austin, TX 78746-6133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 02/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
131278701 | (05) | TX |
BM2185103 | DEA NO (01) | TX |
E48391 | (02) | TX |
H4523 | MEDICAL LICENSE NO (01) | TX |
Y0074202 | DPS NO (01) | TX |