Organization
GORDON B MASSENGALE A MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON B MASSENGALE III M.D. (PRESIDENT)
(318) 728-3263
Entity
Organization
Contact information
Practice address
111 CHRISTIAN DR, RAYVILLE, LA 71269-3658
(318) 728-3263
(318) 728-3095
Mailing address
PO BOX 960, RAYVILLE, LA 71269-0960
(318) 728-3263
(318) 728-3095
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
012197
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1160717
—
LA
Enumeration date
06/15/2010
Last updated
06/15/2010
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