Provider Demographics
NPI:1669512836
Name:MASKA, MONTE D (MD)
Entity type:Individual
Prefix:DR
First Name:MONTE
Middle Name:D
Last Name:MASKA
Suffix:
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:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:2711 S MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5924
Practice Address - Country:US
Practice Address - Phone:417-887-0081
Practice Address - Fax:417-227-1412
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208472308Medicaid
MO137548OtherMO BLUE SHIELD
AR98622OtherARK BLUE SHIELD
MO137548OtherMO BLUE SHIELD
G32533Medicare UPIN