# GORDON B MASSENGALE A MEDICAL CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154642015
- **Authorized official:** GORDON B MASSENGALE III M.D. (PRESIDENT)
- **Authorized official phone:** (318) 728-3263

## Contact information

- **Practice address:** 111 CHRISTIAN DR, RAYVILLE, LA 71269-3658
- **Practice address phone:** (318) 728-3263
- **Practice address fax:** (318) 728-3095
- **Mailing address:** PO BOX 960, RAYVILLE, LA 71269-0960
- **Mailing address phone:** (318) 728-3263
- **Mailing address fax:** (318) 728-3095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 012197 | LA | Yes |

## Other

- **Enumeration date:** 06/15/2010
- **Last updated:** 06/15/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1160717 | — | LA |