Provider Demographics
NPI:1962427625
Name:MASSEY, MICHAEL DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:MASSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 OAKBEND TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3912
Mailing Address - Country:US
Mailing Address - Phone:817-294-9000
Mailing Address - Fax:817-294-9010
Practice Address - Street 1:5801 OAKBEND TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3912
Practice Address - Country:US
Practice Address - Phone:817-294-9000
Practice Address - Fax:817-294-9010
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4621OtherBCBS
TX043122303Medicaid
TXP00052243OtherRR MEDICARE
TX8A2949Medicare ID - Type Unspecified
TX043122303Medicaid