Provider Demographics
NPI:1417138355
Name:MASSEY HAND AND PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:MASSEY HAND AND PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:ZELPH
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-298-2325
Mailing Address - Street 1:1951 N WILMOT RD
Mailing Address - Street 2:BLDG 2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-8000
Mailing Address - Country:US
Mailing Address - Phone:520-750-7166
Mailing Address - Fax:520-886-1929
Practice Address - Street 1:3170 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1227
Practice Address - Country:US
Practice Address - Phone:520-298-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35576208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115539Medicaid
AZ119193Medicare PIN