Healthcare Provider Details

I. General information

NPI: 1003898388
Provider Name (Legal Business Name): DAVID L MASSANARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 E PARADISE FALLS DRIVE STE 201
TUCSON AZ
85712-6687
US

IV. Provider business mailing address

3945 E PARADISE FALLS DRIVE STE 201
TUCSON AZ
85712-6687
US

V. Phone/Fax

Practice location:
  • Phone: 520-615-6200
  • Fax: 520-615-6255
Mailing address:
  • Phone: 520-615-6200
  • Fax: 520-615-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number32467
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: