Provider Demographics
NPI:1649320292
Name:MASSENGILL, RICHARD KEMP (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEMP
Last Name:MASSENGILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:664 HYMETTUS AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2603
Mailing Address - Country:US
Mailing Address - Phone:760-390-1410
Mailing Address - Fax:760-635-0611
Practice Address - Street 1:664 HYMETTUS AVE
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2603
Practice Address - Country:US
Practice Address - Phone:760-390-1410
Practice Address - Fax:760-635-0611
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC37189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC37189OtherMEDICAL LICENSE
CAC37189OtherMEDICAL LICENSE
CAAM8540646OtherDEA NUMBER