Provider Demographics
NPI:1790723971
Name:MASSEY, CLARA V (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:V
Last Name:MASSEY
Suffix:
Gender:F
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-445-8242
Mailing Address - Fax:251-445-8250
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:BLDG. C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-445-8242
Practice Address - Fax:251-445-8250
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15798207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL25-10237OtherUNITED HEALTH CARE
MS00121709Medicaid
AL009935495Medicaid
LA1550264Medicaid
AL000086942Medicaid
FL255663400Medicaid
AL51518399OtherBLUE CROSS
LA1550264Medicaid
E52410Medicare UPIN
MS00121709Medicaid