Organization
BLUE RIDGE DERMATOLOGY PA
Active
Organization
BLUE RIDGE DERMATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JASON MASTERS MD (PRESIDENT TREASURER)
(828) 456-7343
Entity
Organization
Contact information
Practice address
540 HOSPITAL DR, CLYDE, NC 28721-8027
(828) 456-7343
(828) 452-0939
Mailing address
540 HOSPITAL DR, CLYDE, NC 28721-8027
(828) 456-7343
(828) 452-0939
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0122K
BLUE CROSS BLUE SHIELD
—
05
—
890122K
—
NC
Enumeration date
09/19/2005
Last updated
08/22/2020
Update your record
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