Provider Demographics
NPI:1427095421
Name:MASSA, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MASSA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-659-4476
Mailing Address - Fax:303-659-4508
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:SUITE 370
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-659-5800
Practice Address - Fax:303-659-5156
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO33215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01332154Medicaid
COG17762Medicare UPIN
COC527278Medicare ID - Type Unspecified