Provider Demographics
NPI:1225004849
Name:MASSAM, ALFRED ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:ROBERT
Last Name:MASSAM
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 1:6801 US HWY 27 N. STE A-4
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870
Mailing Address - Country:US
Mailing Address - Phone:863-385-3611
Mailing Address - Fax:863-385-3613
Practice Address - Street 1:6801 US HWY 27 N. STE A-4
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870
Practice Address - Country:US
Practice Address - Phone:863-385-3611
Practice Address - Fax:863-385-3613
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016216207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16779Medicare ID - Type Unspecified