Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101031327 | VA |
NPI | 1568464642 |
---|---|
Provider Name | Dr. Caleb R Massey III |
First Address | Fredericksburg, VA 22401-3511 |
Second Address | Fredericksburg, VA 22401-3511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D73388 | (02) | |
P00380300 | MEDICARE RAILROAD (01) | VA |