Provider Demographics
NPI:1134123664
Name:MASSON, MARCOS VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:VINCENT
Last Name:MASSON
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 1:1200 BINZ ST
Mailing Address - Street 2:100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-520-1210
Mailing Address - Fax:713-400-8302
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-520-1210
Practice Address - Fax:713-400-8302
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1304207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130537707Medicaid
TX8B7570Medicare ID - Type Unspecified
TXF48329Medicare UPIN