Provider Demographics
NPI:1255774287
Name:W TRENT MASSENGALE, MD LLC
Entity type:Organization
Organization Name:W TRENT MASSENGALE, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MASSENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-769-7546
Mailing Address - Street 1:17503 OLD JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3930
Mailing Address - Country:US
Mailing Address - Phone:225-313-4560
Mailing Address - Fax:225-673-3069
Practice Address - Street 1:17503 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3930
Practice Address - Country:US
Practice Address - Phone:225-313-4560
Practice Address - Fax:225-673-3069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty