Provider Demographics
NPI:1619062775
Name:MASSARI, RUDOLPH JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:JOSEPH
Last Name:MASSARI
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 1:414 NAVARRO ST
Mailing Address - Street 2:STE 1030
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205
Mailing Address - Country:US
Mailing Address - Phone:210-223-3197
Mailing Address - Fax:210-231-0200
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:STE 1030
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205
Practice Address - Country:US
Practice Address - Phone:210-223-3197
Practice Address - Fax:210-231-0200
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC7039208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C189Z1Medicare UPIN
00A334Medicare ID - Type Unspecified