Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 2003-0490 | NM |
N | 207RC0000X | Internist - Cardiovascular Disease | 23341 | AL |
N | 207RC0000X | Internist - Cardiovascular Disease | MD38877 | TN |
NPI | 1003800988 |
---|---|
Provider Name | Mr. George M Massoud |
First Address | Alamogordo, NM 88310-9740 |
Second Address | Alamogordo, NM 88310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 20/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009932256 | (05) | AL |
2003-0490 | NM LICENSE (01) | NM |
A80823 | (02) | TN |