Individual
GREGG L MASSANELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2700 VINE ST, EL DORADO, AR 71730-6700
(870) 862-1144
(870) 864-0782
Mailing address
PO BOX 10730, EL DORADO, AR 71730-0028
(870) 862-1144
(870) 864-0782
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C8449
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0424120002
DMEPOS
AR
05
—
132799001
—
AR
01
—
17802000000
QUALCHOICE
AR
01
—
200042894
UNITED /RAILROAD MEDICARE
AR
Enumeration date
10/05/2005
Last updated
11/26/2008
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