Doctor Name: | CHARLES RICHARD MASSEY |
NPI Number: | 1407046626 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G5341 |
Business Practice Address: | 103 Goehmann Lane Fredericksburg, TX - 78624 |
Business Phone Number: | 8309902924 |
Business Fax Number: | 8309901629 |
Mailing Address: | 103 Goehmann Lane, FREDERICKSBURG |
State: | TX |
Postal Code: | 78624 |
Phone Number: | 8309902924 |
Fax Number: | 8309901629 |
NPI Enumeration Date: | 07/25/2007 |
NPI Last Update Date: | 07/25/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G5341 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |