Individual
MARY MASTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2100 W IOWA AVE STE A, CHICKASHA, OK 73018
(405) 224-2100
(405) 779-2310
Mailing address
2100 W IOWA AVE STE A, CHICKASHA, OK 73018-2736
(405) 224-2100
(405) 779-2310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34682
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OK
Enumeration date
06/07/2016
Last updated
08/06/2019
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