Individual
GORDON B. MASSENGALE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Enumeration date
07/28/2005
Last updated
11/03/2011
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