Provider Demographics
NPI:1598738114
Name:MASSONE, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:MASSONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2594 TRAILRIDGE DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETE
Mailing Address - State:CO
Mailing Address - Zip Code:80026
Mailing Address - Country:US
Mailing Address - Phone:303-449-7740
Mailing Address - Fax:303-604-5393
Practice Address - Street 1:2594 TRAILRIDGE DR E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3186
Practice Address - Country:US
Practice Address - Phone:303-449-7740
Practice Address - Fax:303-604-5393
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0042908207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO024974OtherKAISER COMMERCIAL NUMBER
CO25850041Medicaid
CO25850041Medicaid
CO366467YK5YMedicare PIN
802069Medicare ID - Type Unspecified