Provider Demographics
NPI:1952398893
Name:MASSENGALE, WILLIAM TRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TRENT
Last Name:MASSENGALE
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 1:5326 O'DONOVAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9153
Mailing Address - Country:US
Mailing Address - Phone:225-769-7546
Mailing Address - Fax:225-769-0471
Practice Address - Street 1:5326 O'DONOVAN DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9153
Practice Address - Country:US
Practice Address - Phone:225-769-7546
Practice Address - Fax:225-769-0471
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023151207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1530000Medicaid
LA1530000Medicaid
5Y739B487Medicare PIN
G55332Medicare UPIN