| Robert C Masterson DO PA Inc | |
|
1901 Mission 66 Vicksburg MS 39180-3711 | |
| (601) 636-0097 | |
| (601) 629-9969 |
| Full Name | Robert C Masterson DO PA Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1901 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Robert C Masterson (PRESIDENT) |
| Authorized Official Contact | 6016360097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert C Masterson DO PA Inc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 | Robert C Masterson DO PA Inc 1901 Mission 66 Vicksburg MS 39180-3711 Ph: (601) 636-0097 |
| NPI Number | 1427112630 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 06/17/2008 |
| Medicare PECOS PAC ID | 5395712145 |
|---|---|
| Medicare Enrollment ID | O20040913000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427112630 | NPI | - | NPPES |
| 00115208 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 14322 (Mississippi) | Primary |
| Provider Name | Robert Calvin Masterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053358853 PECOS PAC ID: 2668449414 Enrollment ID: I20100928000324 |
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