Individual
DR. CLINTON JAMES MASTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2170 SOUTH AVE, SOUTH LAKE TAHOE, CA 96150-7026
(530) 541-3420
Mailing address
1111 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6207
(530) 543-5652
(530) 541-8723
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
12330
NV
207P00000X
Emergency Medicine Physician
234413
NY
207P00000X
Emergency Medicine Physician
44775
CO
207P00000X
Emergency Medicine Physician
Primary
A100433
CA
207P00000X
Emergency Medicine Physician
M7408
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407067168
—
CA
05
—
1407067168
—
NV
Enumeration date
05/24/2007
Last updated
10/19/2020
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