Active NPI
Gordon B. Massengale III, M.D.
- Family Medicine Physician
- Rayville, LA
National Provider Identifier
1255331443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 012197
- Practice address
- 111 Christian Dr
Rayville, LA 71269-3658 - Phone
- (318) 728-3263
- Fax
- (318) 728-3095
- NPI assigned
- Jul 28, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 012197 | LA | Primary |
Addresses
Primary practice location
111 Christian Dr
Rayville, LA 71269-3658
Mailing address
PO Box 960
Rayville, LA 71269-0960
Phone (318) 728-3263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012197 | LA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320278400000",
"number": "1255331443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 960",
"city": "RAYVILLE",
"state": "LA",
"postal_code": "712690960",
"telephone_number": "318-728-3263",
"fax_number": "318-728-3095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 CHRISTIAN DR",
"city": "RAYVILLE",
"state": "LA",
"postal_code": "712693658",
"telephone_number": "318-728-3263",
"fax_number": "318-728-3095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASSENGALE",
"first_name": "GORDON",
"middle_name": "B.",
"name_suffix": "III",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-28",
"last_updated": "2011-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "LA",
"license": "012197",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rayville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.