Provider Demographics
NPI:1154516870
Name:ROBERT H. MASTERS MD, INC.
Entity type:Organization
Organization Name:ROBERT H. MASTERS MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-226-8200
Mailing Address - Street 1:3405 KENYON ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5003
Mailing Address - Country:US
Mailing Address - Phone:619-226-8200
Mailing Address - Fax:619-226-8203
Practice Address - Street 1:3405 KENYON ST
Practice Address - Street 2:SUITE 504
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5003
Practice Address - Country:US
Practice Address - Phone:619-226-8200
Practice Address - Fax:619-226-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA20999208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A209990Medicaid
CAA22415Medicare UPIN
CAA20999Medicare PIN