Provider Demographics
NPI:1053302901
Name:MASSIE, DON CARL (PA C)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:CARL
Last Name:MASSIE
Suffix:
Gender:M
Credentials:PA C
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Mailing Address - Street 1:155 SOLANO STREET
Mailing Address - Street 2:CORNING MEDICAL ASSOCIATES INC
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3511
Mailing Address - Country:US
Mailing Address - Phone:530-824-4663
Mailing Address - Fax:530-824-5204
Practice Address - Street 1:155 SOLANO STREET
Practice Address - Street 2:CORNING MEDICAL ASSOCIATES INC
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3511
Practice Address - Country:US
Practice Address - Phone:530-824-4663
Practice Address - Fax:530-824-5204
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10063363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37403Medicare UPIN
CAOPA100630Medicare ID - Type Unspecified