Provider Demographics
NPI:1831113687
Name:MASSEY, JAMES D JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:MASSEY
Suffix:JR
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 1:230975 CR J
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361
Mailing Address - Country:US
Mailing Address - Phone:308-635-3155
Mailing Address - Fax:
Practice Address - Street 1:2 W 42ND ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4669
Practice Address - Country:US
Practice Address - Phone:308-635-3155
Practice Address - Fax:308-635-2966
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16433207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE040004167OtherPALMENTO GBA RR MEDICARE
NE16433Medicaid
NE480940789Medicaid
WYW308228OtherNORIDAN
NE480940789Medicaid
NED05183Medicare UPIN