Provider Demographics
NPI:1972516961
Name:MASSAR, JANNA L (MD)
Entity Type:Individual
Prefix:MS
First Name:JANNA
Middle Name:L
Last Name:MASSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2208 DALLAS PKWY
Mailing Address - Street 2:SUITE 325C1
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4359
Mailing Address - Country:US
Mailing Address - Phone:972-403-7555
Mailing Address - Fax:972-403-9199
Practice Address - Street 1:2208 DALLAS PKWY
Practice Address - Street 2:SUITE 325C1
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4359
Practice Address - Country:US
Practice Address - Phone:972-403-7555
Practice Address - Fax:972-403-9199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037576801Medicaid
TX037576801Medicaid
TX037576801Medicaid