Provider Demographics
NPI:1417140567
Name:MASSEY, WARNER BARRON (MD)
Entity Type:Individual
Prefix:DR
First Name:WARNER
Middle Name:BARRON
Last Name:MASSEY
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 1:609 N EBRITE
Mailing Address - Street 2:STE 110
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149
Mailing Address - Country:US
Mailing Address - Phone:214-402-7172
Mailing Address - Fax:972-635-3861
Practice Address - Street 1:609 N EBRITE
Practice Address - Street 2:STE 110
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149
Practice Address - Country:US
Practice Address - Phone:214-402-7172
Practice Address - Fax:972-635-3861
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6084208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137980201Medicaid
TXE16369Medicare UPIN
E16369Medicare UPIN
TX137980201Medicaid