Individual
MR. ALVIN MASSENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1017 W 7TH ST, WRAY, CO 80758-1420
(970) 332-4895
(970) 332-4665
Mailing address
1017 W 7TH ST, WRAY, CO 80758-1420
(970) 332-4895
(970) 332-4665
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
60180642
WA
363AM0700X
Medical Physician Assistant
Primary
PA.0003663
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780991034
—
CO
Enumeration date
09/08/2010
Last updated
07/21/2022
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