Provider Demographics
NPI:1952307597
Name:MASSOUMI, MAS G (MD)
Entity Type:Individual
Prefix:DR
First Name:MAS
Middle Name:G
Last Name:MASSOUMI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 N DIXIE HWY
Mailing Address - Street 2:STE 104
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2715
Mailing Address - Country:US
Mailing Address - Phone:561-655-9455
Mailing Address - Fax:561-655-9457
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:STE 104
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2715
Practice Address - Country:US
Practice Address - Phone:561-655-9455
Practice Address - Fax:561-655-9457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL0021516207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55774Medicare UPIN