Organization
MASTBAUM ENDOCRINOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODIE HATTERY (CREDENTIALING COORDINATOR)
(260) 969-7173
Entity
Organization
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7001
(260) 969-7101
Mailing address
7900 W JEFFERSON BLVD, SUITE 201, FORT WAYNE, IN 46804-4128
(260) 969-7100
(260) 969-7771
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01041346
IN
Other
Enumeration date
05/30/2008
Last updated
05/30/2008
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