Provider Demographics
NPI:1003800988
Name:MASSOUD, GEORGE M (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:MASSOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2579 NORTH SCENIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-9740
Mailing Address - Country:US
Mailing Address - Phone:575-434-3225
Mailing Address - Fax:
Practice Address - Street 1:2559 N SCENIC DR
Practice Address - Street 2:SUITE F
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310
Practice Address - Country:US
Practice Address - Phone:575-434-3225
Practice Address - Fax:575-434-8671
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38877207RC0000X
AL23341207RC0000X
NM2003-0490207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932256Medicaid
NM2003-0490OtherNM LICENSE
AL009932256Medicaid