Provider Demographics
NPI:1194793562
Name:MASUR, RICHARD W (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:MASUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 EWING AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1051
Mailing Address - Country:US
Mailing Address - Phone:612-920-8226
Mailing Address - Fax:
Practice Address - Street 1:665 3RD ST SW
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1108
Practice Address - Country:US
Practice Address - Phone:218-346-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22204207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN900283900Medicaid
MN900283900Medicaid