Gordon B Massengale a Medical Corp
Organization Active NPI Family Medicine Physician · Rayville, LA
NPI 1154642015 · NPPES record last updated Jun 15, 2010
Key facts
- NPI
- 1154642015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 012197 (LA)
- Legal business name
- GORDON B MASSENGALE A MEDICAL CORP
- Practice address
- 111 Christian Dr
Rayville, LA 71269-3658 - Phone
- (318) 728-3263
- Fax
- (318) 728-3095
- NPI assigned
- Jun 15, 2010
- Organization subpart
- No
Authorized official
- Name
- Gordon B Massengale III, M.D.
- Title
- President
- Phone
- (318) 728-3263
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 012197 | LA | Yes |
Addresses
Primary practice location
111 Christian Dr
Rayville, LA 71269-3658
Mailing address
PO Box 960
Rayville, LA 71269-0960
Phone (318) 728-3263
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1160717 | Medicaid | LA |
Other providers in Rayville, LA
- Jimmy S Gandy
- Rachel B Gandy
- Stacy G Gandy
- Jennifer Anne Garrett
- Angela Clark Gill
- Ariel Del Rio Graham
- Ramona Grayson
- Pamela Denise Green
- Pearley Grimes
- Guardian Health Clinic, LLC
All providers in Rayville, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.