Provider Demographics
NPI:1639144215
Name:MASSET, RUSS M (PA)
Entity Type:Individual
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First Name:RUSS
Middle Name:M
Last Name:MASSET
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Gender:M
Credentials:PA
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Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0845
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:10085 DOUBLE R BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5860
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-8180
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-12-04
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Provider Licenses
StateLicense IDTaxonomies
NVPA817363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11832766OtherCAQH
Q49743Medicare UPIN
NVV101922Medicare PIN
NVV101923Medicare PIN