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Individual

MR. CARL MACK MASSENGALE II

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CSA

Contact information

Practice address
1904 FISHER RD, MULDROW, OK 74948-2704
(479) 883-7286
Mailing address
1904 FISHER RD, MULDROW, OK 74948-2704
(479) 883-7286

Taxonomy

Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary

Other

Enumeration date
06/01/2011
Last updated
08/19/2014
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