Healthcare Provider Details

I. General information

NPI: 1104814656
Provider Name (Legal Business Name): JAMES YOUNG MASSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 HIGHWAY 62-412
HARDY AR
72542-9468
US

IV. Provider business mailing address

1244 HIGHWAY 62-412
HARDY AR
72542-9468
US

V. Phone/Fax

Practice location:
  • Phone: 870-994-2737
  • Fax: 870-994-7111
Mailing address:
  • Phone: 870-994-2737
  • Fax: 870-994-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2008
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR2008
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: