Provider Demographics
NPI:1528466703
Name:MCMASTER, ANDREW JONATHAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JONATHAN
Last Name:MCMASTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ANDREW
Other - Middle Name:JONATHAN
Other - Last Name:OTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 E GEDDES AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13650 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3561
Practice Address - Country:US
Practice Address - Phone:303-695-1338
Practice Address - Fax:303-695-8814
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-20
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
COPA.0004683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant