Provider Demographics
NPI:1043278625
Name:MASTERS, SALLY RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:RUTH
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-573-6918
Practice Address - Street 1:717 CENTER ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3654
Practice Address - Country:US
Practice Address - Phone:707-433-7214
Practice Address - Fax:707-433-8642
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG71294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E48669Medicare UPIN
CA00G712940Medicare ID - Type Unspecified