Provider Demographics
NPI:1083805279
Name:MASEL, TODD SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:SIMON
Last Name:MASEL
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0539
Mailing Address - Country:US
Mailing Address - Phone:409-772-8053
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:DEPARTMENT OF NEUROLOGY
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0539
Practice Address - Country:US
Practice Address - Phone:409-772-8053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2775812611OtherMYUTMB 2775812611