Provider Demographics
NPI:1407823552
Name:MASANGKAY, GENEROSO (MD)
Entity Type:Individual
Prefix:
First Name:GENEROSO
Middle Name:
Last Name:MASANGKAY
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 1:137 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-833-7599
Mailing Address - Fax:850-833-7434
Practice Address - Street 1:137 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-833-7599
Practice Address - Fax:850-833-7434
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 375272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068302700Medicaid
FLD53329Medicare UPIN
FL068302700Medicaid