Provider Demographics
NPI:1578557872
Name:MASSEY, MINA K (MD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:K
Last Name:MASSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MINA
Other - Middle Name:K
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26136 US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:MO
Mailing Address - Zip Code:64446-9105
Mailing Address - Country:US
Mailing Address - Phone:660-686-2211
Mailing Address - Fax:660-686-2618
Practice Address - Street 1:26136 US HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:MO
Practice Address - Zip Code:64446-9105
Practice Address - Country:US
Practice Address - Phone:660-686-2211
Practice Address - Fax:660-686-2618
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
16418OtherCOX HEALTH
MO171942OtherBLUE CROSS BLUE SHIELD
MO205402027Medicaid
H46964Medicare UPIN
16418OtherCOX HEALTH